Lateral supramalleolar flap: an exceptional flap

Abstract

Introduction: Lateral supramalleolar flap constitutes a versatile and useful alternative for treating defects in distal tibia, ankle and foot. A discussion of the indications, results and surgical techniques in 8 patients treated by the author is made.

Methods: This is an observational retrospective case series study carried out between 2006 and 2010 in the Hospital Universitario San Jorge de Pereira, Colombia, showing our experience with the use of lateral supramalleolar flap in its three varieties to correct soft tissue defects in distal tibia, ankle and dorsum of the foot.

Results: Eight patients were considered suitable for the procedure. In four patients fasciocutaneous island flaps were raised. Three patients sustaining lesions in the dorsum of the foot were treated with pedicled distal-based supramalleolar flap, and a peninsular rotational flap was employed to cover an adjacent defect of the tibia in the remaining patient. In seven out of the eight patients satisfactory defect healing was accomplished, although two of them presented partial vascular compromise of a segment of the flap, which healed uneventfully. There was one failure in a diabetic patient with total flap necrosis, who had to be amputated.

Discussion: The supramalleolar flap must be considered into account as an alternative when free flaps or sural neurocutaneous flap is not available or contra indicated.