Evidence map›Paper›PMID 40794315›Full record

ArticleJournal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology2025

Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns.

Saleh Abualhaj, Mosleh M Abualhaj, Mohd Said Dawod, Maher Alkhateeb, Eyad Alqarqaz, Mohammed Jaber, Rasha Al-Ebbini, Mohammad Alananzh, Lina Alshadfan

Abstract readMulticenter Study
In one paragraph

Article in Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Venous supercharging of the reverse sural artery flap prevents venous salvage procedures : a preliminary 63-case comparative series.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Saleh AbualhajGeneral Surgery Department, Faculty of Medicine, Al-Balqa Applied University, P.O. Box 19117, Al-Salt, Jordan. Saleh.abualhaj@bau.edu.jo.ORCID http://orcid.org/0009-0004-3243-9007
Mosleh M AbualhajDepartment of Networks and Cybersecurity, Al-Ahliyya Amman University, Amman, Jordan.
Mohd Said DawodSpecial Surgery Department, Faculty of Medicine, Mutah University, Al-Karak, Jordan.
Maher AlkhateebPlastic Surgery Department, Royal Medical Services, Amman, Jordan.
Eyad AlqarqazGeneral Surgery Department, Faculty of Medicine, Al-Balqa Applied University, P.O. Box 19117, Al-Salt, Jordan.
Mohammed JaberPlastic Surgery Department, Al Basheer Hospital, Amman, Jordan.
Rasha Al-EbbiniKing's College London NHS Foundation, London, England.
Mohammad AlananzhDepartment of Special Surgery, Faculty of Medicine, Al-Balqa Applied University, Salt, Jordan.
Lina AlshadfanDepartment of Pediatrics, Faculty of Medicine, Al-Balqa Applied University, Salt, Jordan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite its increasing use, comprehensive multicenter data on its survival outcomes and anatomical site-specific performance remain limited.

methodsThis retrospective multicenter case series included all patients who underwent RSAF for distal lower extremity defects between 2015 and 2024 across military, governmental, private, and academic institutions. Data on patient demographics, defect characteristics, surgical technique, and postoperative outcomes were collected and analyzed using Jamovi. Kaplan-Meier survival analysis was used to assess flap survival over time, with subgroup comparisons based on defect site.

resultsA total of 60 patients were included. The overall flap survival rate was 96.7%, with a mean wound healing time of 21.5 days. Venous congestion occurred in 83.3% of cases. Persistent venous congestion occurred in 10% of cases, leading to partial flap necrosis. Flap width, pedicle length, prolonged operative time, and patient-specific factors such as body mass index (BMI) and smoking status were significantly associated with adverse outcomes. Site-specific analysis revealed that RSAFs used for ankle and lower leg defects had a 100% survival rate at 60 months, while heel-based flaps showed a decline in survival to 70.8% at 60 months.

conclusionsRSAF is a highly successful and reliable option for lower extremity reconstruction, especially in resource-variable settings. However, anatomical site, flap design parameters, and modifiable patient risk factors significantly impact outcomes. Long-term surveillance highlights excellent durability in ankle and lower leg reconstructions, while heel-based reconstructions require closer follow-up. Level of Evidence Level III (Retrospective Comparative Study).

Indexed as

Leg InjuriesLower ExtremityPlastic Surgery ProceduresSoft Tissue InjuriesSurgical FlapsAdultAgedFemaleGraft SurvivalHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeYoung AdultFlap survivalLower extremity reconstructionReverse sural artery flapRSAFSoft tissue defects

Identifiers

PMID40794315
PMCPMC12343409

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.