Preoperative Evaluation Of The Sural Flap: Subtraction Angiography Compared With Doppler Ecography

The distally based neurocutaneous flap represents one of the most popular reconstructive techniques for coverage of defects located at the distal lower leg, ankle and proximal foot. Etiology of these defects is generally represented by trauma, tumor excision, venous or arterial ulcers, chronic osteomyelitis, gangrene or unstable scars and electric burns. Meta-analyses performed on groups of patients, especially those including subjects with vascular comorbidities, sustained by personal experience, show significant statistic association between peripheralarteriopathy and immediate, minor or major, complicationswhich recommend its avoidance. The aim of this article was the vascular anatomy study of the the distally based neurocutaneous sural flap of patients with chronic obliterative arteriopathy. The working hypothesis proposed derives from the progresive development of a colateral vascular networkat the level of the sural nerve. This network is difficult to explore preoperatively with the help of conventional Doppler ultrasonography. It is proposed the introduction of subtraction angiography as method of preoperative evaluation of the neurocutaneous sural flap for patients with chronic obliterative arteriopathy. This would allow to analyze and identify the presence of vascular sources that irigate the distally based neurocutaneous sural flap for patients with chronic obliterative artheriopathy and cutaneous or tisular defects that necesitate its use.