Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report

The reverse sural flap is a commonly used surgical option for soft-tissue defects of the distal leg, ankle, and heel in hospitals where microsurgical capabilities are limited. However, one of its most frequent complications is venous congestion, which can lead to partial or total flap necrosis if not promptly addressed. We present the case of a patient with a traumatic crush injury of the right ankle, reconstructed with a reverse-flow sural flap that subsequently developed venous congestion in the immediate postoperative period (<12 hours). A local subcutaneous enoxaparin protocol (low-molecular-weight heparin) was implemented as a salvage strategy. This intervention successfully reversed the clinical signs of venous congestion and preserved approximately 80% of the flap's viability. This report discusses the underlying pathophysiology, the applied protocol, previous evidence, and the clinical implications of this approach.