Venous supercharging of the reverse sural artery flap prevents venous salvage procedures : a preliminary 63-case comparative series.

Abstract

To compare outcomes of standard and supercharged reverse sural artery flap (RSAF) for lower extremity reconstruction and define indications for each technique. Retrospective single-centre study of 63 patients (2013-2025) : 57 standard RSAFs (group C) and 6 supercharged RSAFs (group S). complete flap survival (absence of grade B, C or total necrosis). Secondary endpoints : partial necrosis grading, venous congestion, directed bleeding, hirudotherapy, and surgical revision. Complete flap survival was 87.7% (group C) and 100% (group S) (p = 1.000). Venous congestion occurred in 56.1% and 50.0% (p = 1.000). Directed bleeding (22.8%) and hirudotherapy (14.0%) were required in group C versus 0% in group S, where all episodes resolved spontaneously. Standard RSAF is a robust, accessible first-line option for non-microsurgeons : 87.7% complete survival with a single total flap loss among 57 cases. Venous supercharging eliminates the need for postoperative venous salvage procedures and should be reserved for very high congestion risk or no viable reconstructive alternative.