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[The supramalleolar flap. Our experience in 35 cases]
1Service assistance mains, hôpital Jeanne d'Arc, CHRU Nancy, BP 303, 54201 Toul, France.
Annales De Chirurgie Plastique Et Esthetique
|May 9, 2001
Summary
The supramalleolar flap is effective for foot and ankle reconstruction, offering satisfactory plastic results in most cases. While venous congestion can occur, it remains a valuable option for complex lower extremity defects.
Area of Science:
- Orthopedic Surgery
- Plastic Surgery
- Reconstructive Microsurgery
Context:
- The supramalleolar flap, introduced by Masquelet et al. in 1988, is a reconstructive technique for lower extremity defects.
- This study evaluates 35 cases of supramalleolar flap usage, analyzing arterial supply variations and clinical outcomes.
Purpose:
- To assess the efficacy and outcomes of the supramalleolar flap in reconstructive surgery.
- To analyze the influence of arterial blood supply patterns (anterograde, retrograde, mixed) on flap viability.
- To compare the supramalleolar flap with alternative local flaps for lower extremity coverage.
Summary:
- Thirty-five supramalleolar flaps were analyzed, with 33 achieving satisfactory aesthetic results.
- Mixed or retrograde arterial supply was noted in 27 and 8 cases, respectively.
- The flap demonstrated excellent outcomes for medial malleolus, Achilles tendon, and dorsal foot coverage, but not for weight-bearing heel reconstruction.
- Venous congestion occurred in five cases, leading to partial necrosis in three, despite using a large subcutaneous pedicle.
Impact:
- The supramalleolar flap is a reliable option for reconstructing various lower extremity defects, particularly around the ankle and foot.
- Understanding arterial supply variations is crucial for optimizing flap success.
- It offers advantages over the sural flap for distal foot coverage and serves as a viable alternative to free flaps in select cases.