Skip to main content Skip to main navigation menu Skip to site footer

The lateral supramalleolar flap as solution for lower leg, ankle and foot defects: a surgical case series



Abstract

Introduction. One of the most challenging regions of the body to cover is the lower part of the leg, the ankle, and the foot, especially with the exposure of bones or tendons. Many options for covering soft tissue defects in this area have been proposed. This article describes the lateral supramalleolar flap, which is used for the reconstruction of defects of the lower leg, ankle, heel, and foot. This flap is a surgical technique to salvage the lower extremity due to its large skin paddle and a wide rotation arc. In this case series, patients with lower leg and ankle defects requiring flaps had the lateral supramalleolar flaps performed. This article discusses the overview, technique, and outcomes.

Methods. These flaps were performed under spinal anesthesia and tourniquet control.  The upper limit of the flap was about 8 cm from the popliteal crease, and the lower border was 5 cm from the axis of the ankle joint. The lateral extent of the flap was up to the fibula, contrary to mid-calf. The flap was harvested in the sub-facial plane, and the donor site was grafted.

Results. The Flap was generally easy to raise and secure in place at the donor site. Partial necrosis of the flap was reported in one case. The overall donor site morbidity was minimal.

Conclusion. The lateral supramalleolar flap is a reliable and useful flap for coverage of the lower third of the leg, ankle, and dorsal foot defects. It is a viable option available to the reconstructive surgeon, especially with the exposure of bones or tendons. 

Keywords: Ankle Lower Leg Foot Soft Tissue Defect Lateral Supramalleolar Flap

References

  1. Pontén B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg. 1981;34(2):215–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7236984
  2. Bajantri B, Bharathi RR, Sabapathy SR. Wound coverage considerations for defects of the lower third of the leg. Indian J Plast Surg. 2012;45(2):283–90. Available from: https://pubmed.ncbi.nlm.nih.gov/23162228
  3. Ramesh P, Kumar AS, Anita C, Krishnaveni A, Rangaswamy G. A Comparative Study of Soft Tissue Cover in Compound Lower Limb Trauma at an Interval of a Decade. Int J Sci Res. 2015;4(8):2094–107. Available from: https://www.ijsr.net/get_abstract.php?paper_id=SUB157510
  4. Acland RD, Schusterman M, Godina M, Eder E, Taylor GI, Carlisle I. The Saphenous Neurovascular Free Flap. Plast Reconstr Surg. 1981;67(6):763–74. Available from: http://dx.doi.org/10.1097/00006534-198106000-00009
  5. Wei F-C, Mardini S. Free-Style Free Flaps. Plast Reconstr Surg. 2004;114(4):910–6. Available from: http://dx.doi.org/10.1097/01.prs.0000133171.65075.81
  6. Taylor GI, Pan WR. Angiosomes of the Leg: Anatomic Study and Clinical Implications. Plast Reconstr Surg. 1998;102(3):599–616. Available from: http://dx.doi.org/10.1097/00006534-199809030-00001
  7. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg. 1991;44(1):53–4. Available from: http://dx.doi.org/10.1016/0007-1226(91)90179-n
  8. Valenti P, Masquelet AC, Romana C, Nordin JY. Technical refinement of the lateral supramalleolar flap. Br J Plast Surg. 1991;44(6):459–62. Available from: http://dx.doi.org/10.1016/0007-1226(91)90207-z
  9. Zekri A, King W. Success of skin grafting on a contaminated recipient surface. Eur J Plast Surg. 1995;18(1). Available from: http://dx.doi.org/10.1007/bf00183697
  10. Masquelet AC, Beveridge J, Romana C, Gerber C. The Lateral Supramalleolar Flap. Plast Reconstr Surg. 1988;81(1):74–84. Available from: http://dx.doi.org/10.1097/00006534-198801000-00014
  11. Hou C, Chang S, Lin J, Song D. Peroneal Artery Anterolateral Supramalleolar Flap. In: Surgical Atlas of Perforator Flaps. Springer Netherlands; 2015. p. 205–11. Available from: https://link.springer.com/chapter/10.1007/978-94-017-9834-1_27
  12. Barclay TL, Sharpe DT, Chisholm EM, Tolhrust DE. Cross-Leg Fasciocutaneous Flaps. Plast Reconstr Surg. 1983;72(6):847. Available from: http://dx.doi.org/10.1097/00006534-198312000-00022
  13. Bhattacharya V, Reddy GR, Goyal S, Kumar U. Skeletonised retrograde distal perforator island fasciocutaneous flaps for leg and foot defects. J Plast Reconstr Aesthetic Surg. 2007;60(8):892–7. Available from: http://dx.doi.org/10.1016/j.bjps.2007.02.009
  14. Bhattacharya V, Raveendra Reddy G. Distal perforator based cross leg flaps for leg and foot defects. Indian J Plast Surg. 2005;38(01):18–21. Available from: http://dx.doi.org/10.1055/s-0039-1699064
  15. Ahmed SK, Hashmi PM. Delayed supramalleolar flap--an innovative technique for enhanced viability. J Ayub Med Coll Abbottabad. 2005;17(3):76–9.

How to Cite

Nsaful, K. O., & Gentil, S. (2020). The lateral supramalleolar flap as solution for lower leg, ankle and foot defects: a surgical case series. Bali Medical Journal, 9(2), 572–576. https://doi.org/10.15562/bmj.v9i2.1812
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
0

Total
21

Share

Search Panel

Kwesi Okumanin Nsaful
Google Scholar
Pubmed
BMJ Journal

Stephane Gentil
Google Scholar
Pubmed
BMJ Journal