Ni Made Astri Pratyastiti, Agus Roy Rusly Hariantana Hamid, I Gusti Putu Hendra Sanjaya

Reverse fasciocutaneous sural artery island flap on chronic wound: A rare case report

Introduction

Reverse fasciocutaneous sural artery island flap on chronic wound: a rare case report. Rare case report: Reverse fasciocutaneous sural artery island flap effectively reconstructs chronic distal foot wounds post-trauma. A vital alternative to free flaps for complex defects.

Abstract

Introduction: Distal leg and foot defects with exposed bone or fixation hardware are difficult to reconstruct because local tissue is limited and skin grafting is often inadequate. While free flaps are effective, they require microsurgical resources and suitable recipient vessels. The reverse fasciocutaneous sural artery island flap provides a regional alternative that preserves major arteries and avoids microsurgical anastomosis. This report aimed to describe a rare case about reverse fasciocutaneous sural artery island flap on chronic wounds. Case: A 51-year-old male patient developed a progressive chronic wound on his right foot three months after a 15-meters fall, causing an open fracture with right subtalar joint dislocation. He underwent open reduction and joint-spanning external fixation, followed by revision external fixation and debridement two months later. Examination showed an 8 × 7 cm lateral foot defect with exposed bone, slough, and exudate, and a 1 × 1 cm medial wound with granulation tissue. After definitive debridement, coverage was achieved using a reverse fasciocutaneous sural artery island flap planned with Doppler perforator mapping, with split-thickness skin grafting for a secondary defect. Postoperatively, the limb was immobilized with a posterior backslab, elevated, and kept non-weight-bearing for four weeks. At one month, the flap survived completely with no residual bone exposure. Conclusion: Reverse sural artery island flap is appropriate for chronic distal foot defects after trauma when skin grafting fails, and free flap is unsuitable.

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