Deep burns involving the foot and ankle represent a significant reconstructive challenge. This paper serves as a clinical review of the modified reversed superficial artery flap. The authors describe key anatomy, surgical steps and clinical outcomes in a small series. The authors included 12 patients over a seven year period. Only six flaps were for burns, the rest for lower limb trauma. All patients had foot and ankle defects with a maximum defect diameter of 18x10cm. The authors detail flap survival in all 12 cases with one elderly patient requiring interventional radiology to improve vascularity secondary to a popliteal artery stenosis. In this case, despite partial necrosis the flap survived. No foot pparathesia was reported in any case. Key advantages of this flap detailed in the paper are preservation of the superficial peroneal nerve (traditionally sacrificed in the superficial peroneal neurocutaneous flap), use in medium to large defects, speed over microsurgical reconstruction and good flap survival rates in their hands. The apparent disadvantages appear to be issues with venous congestion / arterial insufficiency with a tunneled pedicle and the need to skin graft the donor site. The authors fail to record operative time taken for this procedure, which requires careful dissection of the peroneal nerve, making comparison with different surgical options difficult. It is almost certainly something to be reserved for high volume units with expertise in lower limb reconstruction. The authors report a small case series presenting a flap that may serve as a useful alternative to free flap surgery in foot and ankle defects following deep burns or trauma. It accurately details the key surgical anatomy and operative steps with very helpful illustrations.

Modified reversed superficial peroneal artery flap in reconstruction of ankle and foot defects following severe burns.
Li SJ, Cheng H, Fang X, et al.
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Calum Honeyman

St John’s Hospital, Livingston, UK.

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