Background and Objective:

The reverse flow sural flap has won great popularity, but some authors report frequent complications of total or partial flap necrosis.

We present a number of technical modifications to increase the viability of the flap when it is necessary to design it to its fullest extent to cover large defects in the foot.

Methods:

From August 2005 to August 2013, 4 patients underwent the procedure of reverse flow sural flap mega-high flap for foot reconstruction. The flaps ranged from 7 x 17 cm to 15 x 22 cm in size. The average follow-up was 60 months.

The 3 modifications that we usually perform when making this flap are: 1.- The deep fascia is incised and lifted 1.5 cm broader than the skin island. 2.- We keep the width of the adipofascial pedicle as wide as possible. 3.- We habitually suture later on after the first procedure the flap, allowing the edema to expand.

Results:

No partial or total necrosis was neither observed, nor other postoperative complications. All the flaps allowed the reconstruction of the defects, without needing other complementary flaps.

Conclusions:

We believe that the extent of the defects and their successful reconstruction with this type of megaflap, in which we have applied the changes described, justifies the presentation of our experience. However, we note that the 4 patients had no vascular risk conditions, in which it would be advisable to delay the flap or select other reconstructive techniques.

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