Sanjay DHAR, Devika RAKESH
Turkish Journal of Plastic Surgery - 2026;34(1):8-14
Background: Soft-tissue defects involving the distal third of the leg, ankle, and foot pose a significant challenge for reconstruction due to poor circulation and paucity of available local tissue. The extended Reverse Sural Artery Flap (eRSAF) offers a reliable and local reconstructive option in such cases. This study evaluates the clinical use and outcomes of eRSAF in various lower limb defects. Materials and Methods: A retrospective study was conducted including 25 patients who underwent eRSAF reconstruction over 5 years. Data concerning patient demographics, comorbidities, defect characteristics, associated fractures, complications, and clinical outcomes were extracted from the medical records and analyzed. Results: The cohort had a male predominance (88%), with majority of patients in the age group of 15-30 years. Road traffic accidents were the leading cause of defects (56%). The heel pad was the most affected site (36%) followed by the tendoachilles region (28%). Defect sizes ranged from 9 cm2 to 120 cm2 (mean: 24.88 +/- 11.68). Complications occurred in four patients, of which two cases developed partial flap necrosis (both smokers) which was managed by flap advancement in one and split-thickness skin grafting in the other case. In the third case, complete flap loss was documented which required a secondary procedure of dorsalis pedis artery flap. Fourth one developed postoperative infection which was managed with wound bed debridement, antibiotics, and dressings. Conclusion: The extended RSAF with primary delay is a safe and effective alternative to free tissue transfer for distal leg and foot reconstruction, especially in the resource-limited settings providing an extended reach with reasonably satisfactory coverage with manageable complication rates.
