Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Distally based lateral supramalleolar flap: for reconstructing distal foot defects in India: a prospective cohort study

  • Raja Kiran Kumar Goud (Department of Plastic Surgery, Osmania General Hospital, Osmania Medical College) ;
  • Lakshmi Palukuri (Department of Plastic Surgery, Osmania General Hospital, Osmania Medical College) ;
  • Sanujit Pawde (Department of Plastic Surgery, Osmania General Hospital, Osmania Medical College) ;
  • Madhulika Dharmapuri (Department of Plastic Surgery, Osmania General Hospital, Osmania Medical College) ;
  • Swati Sankar (Department of Plastic Surgery, Osmania General Hospital, Osmania Medical College) ;
  • Sandeep Reddy Chintha (Department of Plastic Surgery, Osmania General Hospital, Osmania Medical College)
  • Received : 2023.02.01
  • Accepted : 2023.04.18
  • Published : 2023.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction. Methods: The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed. Results: We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases. Conclusions: The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.

Keywords

References

  1. Lu TC, Lin CH, Lin CH, Lin YT, Chen RF, Wei FC. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011;64:386-93.
  2. Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 1985;76:354-63. https://doi.org/10.1097/00006534-198509000-00003
  3. Daniel RK, Kerrigan CL. Skin flaps: an anatomical and hemodynamic approach. Clin Plast Surg 1979;6:181-200. https://doi.org/10.1016/S0094-1298(20)32064-2
  4. Romana MC, Masquelet AC. Vascularization of the inner border of the foot: surgical applications (24.06.88). Surg Radiol Anat 1989;11:177-8. https://doi.org/10.1007/BF02096478
  5. Cormac GC, Lamberty BG. The arterial anatomy of skin flaps. 2nd ed. Churchill Livingstone; 1994.
  6. Masquelet AC, Romana MC. Lateral supramalleolar flap. In: Strauch B, Vasconez LO, Herman CK, Lee BT, editors. Grabb's encyclopedia of flaps. Vol. 2. 4th ed. Wolters Kluwer; 2015. p. 1488-91.
  7. Ritz M, Mahendru S, Somia N, Pacifico MD. The dorsalis pedis fascial flap. J Reconstr Microsurg 2009;25:313-7. https://doi.org/10.1055/s-0029-1215541
  8. Sugg KB, Schaub TA, Concannon MJ, Cederna PS, Brown DL. The reverse superficial sural artery flap revisited for complex lower extremity and foot reconstruction. Plast Reconstr Surg Glob Open 2015;3:e519.
  9. Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D. The distally based sural flap. Plast Reconstr Surg 2007;119:138e-48e. https://doi.org/10.1097/01.prs.0000259203.79909.7e
  10. Tharayil J, Patil RK. Reverse peroneal artery flap for large defects of ankle and foot: a reliable reconstructive technique. Indian J Plast Surg 2012;45:45-52. https://doi.org/10.4103/0970-0358.96584
  11. Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 1981;34:215-20. https://doi.org/10.1016/S0007-1226(81)80097-5
  12. Andrei R, Popescu SA, Zamfirescu D. Lower limb perforator propeller flaps: clinical applications. Chirurgia (Bucur) 2014;109:299-309.
  13. Sahu S, Gohil AJ, Patil S, Lamba S, Paul K, Gupta AK. Distally based peroneus brevis muscle flap: a single centre experience. Chin J Traumatol 2019;22:108-12. https://doi.org/10.1016/j.cjtee.2018.08.006
  14. Mehmood Hashmi P, Musaddiq A, Hashmi A, Zahid M. Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients. Ann Med Surg (Lond) 2021;73:103109.
  15. Lee YH, Rah SK, Choi SJ, Chung MS, Baek GH. Distally based lateral supramalleolar adipofascial flap for reconstruction of the dorsum of the foot and ankle. Plast Reconstr Surg 2004;114:1478-85. https://doi.org/10.1097/01.PRS.0000138751.53725.67
  16. Uysal AC, Alagoz MS, Sensoz O. Distally based lateral supramalleolar adipofascial flap. Plast Reconstr Surg 2006;117:685-6. https://doi.org/10.1097/01.prs.0000197911.86567.67