Versatility of The Sural Flap for Reconstruction of Leg Defects: Experience of the LIC. Adolfo López Mateos Medical Center in Patients with Limited Access to Microsurgery

The sural flap is a reliable reconstructive option for patients with defects ranging from the knee and popliteal fossa to the distal third of the leg, including the ankle, particularly in settings where microsurgery is unavailable or inaccessible due to patient-related factors. Its consistent vascular supply, technical simplicity, and versatility make it a key tool in reconstructive surgery. This study aims to evaluate the versatility, effectiveness, and complications of the sural flap in the reconstruction of leg defects in patients without access to microsurgery, through a retrospective analysis conducted at the Lic. Adolfo López Mateos Medical Center. Among 14 patients, 13 (92.8%) achieved successful flap integration. One patient (7.1%) developed vascular pedicle thrombosis within 24 hours, requiring flap takedown and surgical reintervention. Minor complications included seroma formation (<2 ml) in 3 cases, wound dehiscence less than 1 cm in 2 cases, and greater than 1 cm in one case, which was resolved with an outpatient skin graft. Transient venous congestion occurred in 4 reverse flaps. All patients recovered functional ambulation, and 12 (85.7%) reported satisfaction with both aesthetic and functional outcomes. Thirteen patients were discharged within 48 hours postoperatively. The pedicled sural flap is a dependable option for lower limb reconstruction, offering high success rates, low morbidity, and favorable patient acceptance in terms of function and aesthetics. Its use should be especially considered when effective soft tissue coverage is required without the need for microsurgical techniques.