Mahmood Reza Ashab-Yamin - Assistant Professor, Department of Plastic Reconstructive Surgery, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
Amir Reza Sadeghifar - Assistant Professor, Department of Orthopedic Surgery, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
Alireza Saiid - Associate Professor, Department of Orthopedic Surgery, Shahid Bahonar Hospital AND Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
Maryam Gharehgozli - General Practitioner, Department of Plastic Reconstructive Surgery, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran

Background & Aims: Distal leg, ankle and foot injuries are relatively common; and because of lack of soft tissue and poor blood supply in these areas, one of the common problems in these patients is soft tissue necrosis. Exposed orthopedic implants can be used as open reduction internal fixator (ORIF) in these regions. Methods: During ۲۰۱۳-۲۰۱۴, ۱۴ patients (۱۱ men and ۳ women) with a mean age of ۳۰ years were enrolled the study in the Department of Plastic and Reconstructive Surgery, Shafa Hospital, Kerman, Iran. All the patients were referred from the Department of Orthopedic Surgery because of exposed orthopedic implants. The minimum and maximum size of the defects was ۳ × ۵ and ۱۱ × ۱۵ cm, respectively. ۷ defects were in distal leg, ۳ in foot, ۲ in ankle and ۲ in distal leg and ankle together. After measuring the defect, sural flap based on sural artery and nerve was prepared and transferred with a rotation of ۱۸۰ degrees to the defect site over the exposed orthopedic implants, before the separation. Results: In all ۱۴ patients, the healing was complete. In ۲ cases, we had to remove the prostheses because of infection and in ۳ cases, partial necrosis was seen; and in ۴ cases, a hypertrophic scar was seen in donor site and a neurosensorial deficit was seen in the sural nerve sensory areas. But in all of them, the sural flap was successful and there was no need to replace this flap to another one. Conclusion: Due to the good clinical results, sural flap can be a viable alternative to cover the exposed prostheses of distal leg, ankle and foot.

Distal leg injury, Exposed orthopedic implants, Sural flap