Use of Biodegradable Temporizing Matrix for Donor and Recipient Site Wound Healing in Delayed Reverse Sural Flap: A Case Report

Abstract

Introduction: Reconstruction of distal third leg soft tissue defects is challenging, particularly in patients with multiple co-morbidities. Whilst the reverse sural artery (RSA) flap remains a viable reconstructive option, flap failure due to torsion, congestion, and necrosis persists. Case Presentation: This case report presents a patient who underwent a staged RSA flap surgery, with initial application of a biodegradable temporising matrix (BTM) over both the donor site and the heel defect. This was performed with three aims: to create a physical interface as an adjunct to surgical delay; to improve donor site granulation tissue quality in preparation for skin grafting; and to establish a granulation tissue layer over the bony defect to promote a granulating wound bed suitable for definitive reconstruction.

Conclusions: The application of BTM appeared to facilitate an effective adjunct to surgical delay and improved flap donor site contour. This case report suggests that the use of BTM across both donor and recipient site wound beds may represent a feasible and promising adjunct in staged RSA flap reconstruction, though further studies are required to substantiate these findings. 1,8 INTRODUCTION lower limb . Flap delay has been shown to improve 7 flap viability . However, complications including Reconstruction of soft tissue defects in the marginal necrosis, partial flap loss, and total flap distal third of the leg is a technically demanding failure - attributable to pedicle torsion, venous procedure, particularly in patients with multiple congestion, or hypoperfusion, have reported rates of 1,2 2,9,10 co-morbidities . The relative scarcity of local soft up to 33% . In addition, donor sites requiring skin tissue, combined with poor regional vascularity, grafting have been associated with scar contracture, 3,4 11 predisposes this anatomical zone to complications . dysaesthesia, and aesthetic problems . On top of that, timely and reliable soft tissue The biodegradab