The Reverse Sural Flap: Modifications to Improve Efficacy in Foot and Ankle ReconstructionAfifi, Ahmed M. MD, MSc, MRCS*†; Mahboub, Tarek A. MD†; Losee, Joseph E. MD, FACS*; Smith, Darren M. MD*; Khalil, Haitham H. MD, MSc, MRCS†‡Annals of Plastic Surgery: October 2008 - Volume 61 - Issue 4 - p 430-436 doi: 10.1097/SAP.0b013e318160c165 Reconstructive Surgery and Burns Buy Abstract Author InformationAuthors Article MetricsMetrics The aim of this work is to evaluate the efficacy of the reverse sural flap in covering defects in the foot and ankle region when certain technical modifications are employed. We provide a retrospective review of 32 consecutive reverse sural flaps for foot and ankle defects, and compare the technique and results with other reports. There were 23 fasciocutaneous flaps, 7 fascial flaps, and 2 tissue-expanded flaps. Four flaps (12.5%) suffered significant flap loss, and 4 patients had delayed healing. Several modifications are suggested to increase the versatility of the sural flap in covering foot and ankle defects, including preserving the mesentery connecting the sural nerve to the deep fascia, inclusion of skin of the upper third of the leg, limiting pedicle width to 2 cm with preservation of a tongue-like skin process all along its length, and generous release of the fascia over the peroneal compartment. In addition, we describe the use of tissue expanded sural flaps. From the *Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and †Plastic Surgery, Cairo University, Egypt. Received July 25, 2007 and accepted for publication, after revision, October 31, 2007. Reprints: Ahmed Afifi, MD, MSc, MRCS, 9125 Copper Avenue, Apt 324, Albuquerque, NM, 87123. E-mail: email@example.com. © 2008 Lippincott Williams & Wilkins, Inc.