Is it possible to perform reverse sural artery flap on lower limbs where the main trunk of the peroneal artery is interrupted?

As blood flow to the reverse sural artery flap (RSAF) occurs via the peroneal artery, the health of the peroneal artery is generally considered important. In severe limb injuries, the main trunk of the peroneal artery is often disrupted at the fracture site, which brings uncertainty in the use of RSAF. We hypothesized that RSAF could be used even in cases where the main trunk of the peroneal artery is interrupted if retrograde blood flow from the plantar side forms a communication network with the superficial sural artery. Therefore, we performed RSAF in cases where the blood flow of the communicating branch could be confirmed. This study included patients who underwent RSAF when the main trunk of the peroneal artery was interrupted by trauma. Patient demographics, characteristics of injury, and treatment course were obtained from medical records. The outcome of this study included flap survival and complications, such as partial necrosis or flap infection. Five limbs that underwent RSAF met the inclusion criteria. In all cases, the skin flaps survived and soft tissue reconstruction was completed. Infection and partial necrosis of the skin flaps were observed in 2 cases each. This study showed that the RSAF can be used, even in cases where the main trunk of the peroneal artery had been interrupted, if retrograde blood flow from the plantar side forms a communication network with the superficial sural artery.