The Efficacy of Intermittent Controlled Phlebotomy in Reverse Sural Artery Flap Surgery in Terms of Flap Congestion and Flap Survival

Objectives: To determine the efficacy of intermittent controlled phlebotomy in reverse sural artery flap surgery in terms of flap congestion and flap survival. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar 2021 to Feb 2022. Methodology: A total of 76 patients with lower limb skin defects requiring reconstruction were included in our study. Patients who suffered from neoplastic disease, those who had active infections or had received previous surgery for the defect were excluded. All patients underwent reverse sural artery flap repair. Patients in Group A received intermittent controlled phlebotomy by inserting 18 Gauge IV cannula in short saphenous vein during initial phase of flap harvest, while those in Group B did not. All patients were followed up for six-weeks post-surgery for the development of complications such as venous congestion. Results: Our patients had a mean age of 46.32±19.06 years, of whom 43(56.6%) were women. Venous congestion occurred in 2(5.3%) cases with intermittent phlebotomy versus 10(26.3%) without it, (p=0.012). Flap necrosis also occurred at a lower rate: 2(5.2%) versus 8(21.1%) in those without it, (p=0.042). Remaining complications such as surgical site infections, paraesthesias, limitation of mobility and donor site complications had similar incidences across the two groups, (p>0.05). Conclusion: Cases undergoing intermittent controlled phlebotomy have better outcomes in terms of the occurrence of complications versus those patients who do not receive the intervention.