Distally Based Sural Flap for Soft-Tissue Coverage of the Leg and Ankle: Experience from Kati University Hospital

The study aimed to describe the indications and evaluate the clinical outcomes of the distal sural flap for the coverage of soft-tissue defects of the leg and ankle at the University Hospital of Kati in Mali

A retrospective descriptive study was conducted over a five-year period and included 26 patients (22 males, 4 females; mean age 31.3 years, range 13–78 years) who underwent reconstruction with a distally based sural flap. Data collected included demographics, etiology, defect location, flap type, complications, and outcomes. Results were assessed according to functional and aesthetic criteria.

Soft tissue coverage was required for the lower third of the leg in 50% of cases, the ankle in 42.3%, and the heel in 7.7%. Five flaps were performed using the cross-leg technique. Complete flap survival with satisfactory healing occurred in 65.4% of patients. Venous congestion was the most common complication, followed by partial or total flap necrosis. Functional and cosmetic results were rated as very good in 65.4%, good in 23.1%, and poor in 11.5% of cases.

Reconstruction of soft-tissue defects in the distal lower limb remains challenging due to complex anatomy, poor cutaneous vascularization, and limited muscular coverage. Most flaps were indicated for traumatic tissue loss, although other reported indications include postoperative complications, diabetic foot ulcers, tumor resection, and burn sequelae.

The distally based sural flap remains a simple, dependable, and effective method for reconstruction of soft tissue defects of the distal leg and ankle.