Effectiveness of Retrograde Wide Pedicle Double-Blood Supply Flaps from the Medial Lower Leg in Reconstructing Foot and Ankle Soft Tissue Defects

Abstract

This study evaluated the clinical efficacy of a retrograde wide pedicle double-blood supply flap from the medial aspect of the lower leg, which includes nutrient vessels from the saphenous nerve and the medial malleolus perforating branch of the posterior tibial artery, in reconstructing soft tissue defects in the foot and ankle area. A retrospective analysis was conducted on 15 patients, ranging in age from 27 to 49 years, who had undergone this surgical technique between March 2018 and July 2022 due to injuries from car accidents or heavy object impacts. These patients experienced various types of soft tissue defects, including those with and without associated bone fractures. During the postoperative follow-up, which averaged 12 months, it was observed that two patients experienced initial complications such as flap swelling and skin discoloration, which were effectively managed with conservative treatments such as pedicle suture removal, manual massage, and limb elevation. By the end of the follow-up period, the majority of cases showed excellent results with good flap appearance and texture, no reported surgical pain, and high patient satisfaction. Furthermore, the functionality of the ankle was significantly improved, with restored range of motion in both dorsiflexion and plantar flexion. The results suggest that the retrograde wide pedicle double-blood supply flap is highly effective for reconstructing soft tissue defects in the foot and ankle regions, providing a stable blood supply and good venous return without the necessity for vascular anastomosis. This makes it a valuable option for surgical reconstruction in complex cases where tissue viability and functional recovery are paramount.