Distally Based Lateral Supramalleolar Adipofascial Flap for Reconstruction of the Dorsum of the Foot and Ankle

Abstract

Soft-tissue reconstruction of the dorsum of the foot and ankle has long been a challenge for reconstructive surgeons. Limitations in the available local tissue and donor-site morbidity restrict the options. In an effort to solve these difficult problems, the authors have begun to use a distally based lateral supramalleolar adipofascial flap. This report presents the authors' early experience with seven patients treated with this flap. The patients' ages ranged from 5 to 26 years; four of the patients were male and three were female. The cause of the soft-tissue defects involved acute trauma and chronic scar contracture. The flap and the adjoining raw area were covered with a full-thickness skin graft, and the donor site at the lateral aspect of the leg was closed primarily without grafting. A skin graft was taken from the groin area, which was closed primarily. Compared with the other flaps, this adipofascial flap was thinner and produced less bulkiness to the recipient site and minor aesthetic sequelae to the donor site. It is believed that this flap is versatile and effective and is a good addition to the available techniques used by reconstructive surgeons for coverage of the dorsum of the foot and ankle.

Peroneal artery perforator‐based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: Case report and literature review

“…The advantage here is the avoidance of bulk that would otherwise result from a fasciocutaneous flap as well as providing a gliding surface for extensor tendons of the foot. 21 Free tissue transfer utilizing a lateral lower leg flap based on the peroneal perforators has been described for reconstruction of remote wounds of the head and neck 20 and hand and elbow. 24 These flaps have adequate pedicle length of 4-6 cm and spare the sacrifice of a major leg vessel.…”

Reverse lateral supramalleolar adipofascial flap and skin grafting for one‐stage soft tissue reconstruction of foot and ankle joint

“…The disadvantages of this flap are a scar on the donor site that is particularly not esthetic to women, and possible complications such as partial necrosis and formation of a neuroma, which require preoperative explanation on morbidity of the donor site and delayed treatment of the wound due to partial necrosis. 3,[5][6][7]12 The incidence of partial necrosis was reported at 20% by Demiri et al 5 and at 7% by Voche et al 7 implying that the reliability on the pedicle is not high compared with the reverse sural artery flap. Although direct comparison was difficult as the skin was not included in the flap of our study, we did not observe partial necrosis in the flap with a maximum size of 6 3 4 cm.…”

“…To reduce excessive scar formation in the donor site, one of the disadvantages of a lateral supramalleolar flap, Lee et al 3 designed a reverse lateral supramalleolar adipofascial flap. This flap makes it possible to preserve the skin, leave the main artery intact, lower the morbidity of the donor site, elevate in a thin flap, provide good esthetic results to the donor site, reconstruct soft tissue defects in the toe with the distally located pivot point, elevate in a large-sized flap, and operate with a less challenging technique.…”

“…Another pedicled flap available is a lateral supramalleolar flap, which has disadvantages such as the inevitable sacrifice of the superficial peroneal nerve and the need for skin grafting to the donor site. [3][4][5][6][7] To overcome the disadvantages, a flap elevated in the form of an adipofascial flap to preserve the superficial peroneal nerve and make the flap thinner has been introduced. 3 However, it requires an additional full-thickness skin graft over the flap five to seven days from the operation.…”

Management of the soft tissue extremity degloving injuries with the full-thickness grafts obtained from the avulsed flap

“…[20] In addition, reconstructions with flaps have the disadvantage of sacrificing the intact structures for wound closure. [21,22] Thus, repair with flap should be restricted to the cases where direct bone, joint, or neurovascular structures are exposed.…”