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Published on: January 24, 2018
[Lateral supramalleolar flaps for reconstruction in the ankle and foot]
E L Hierner1, C Corterier, R Hierner
1Department für Plastische, Ästhetische, Wiederherstellungs- und Hand-Chirurgie, Stiftung Krankenhaus Bethanien für die Graftschaft Moers, Bethanienstr. 21, 47441, Moers, Deutschland. robert.hierner@bethanienmoers.de
Objective:
Defect reconstruction by transposition of well-vascularized thin and pliable skin.
Indications:
Defect coverage involving the antero- and dorsolateral distal one third of the lower leg, the dorsolateral and dorsomedial hindfoot and dorsal midfoot.
Contraindications:
Severe peripheral arterial occlusive disease (PAOD), previous trauma at the anterolateral aspect of the lower leg and foot.
Surgical Technique:
Lateral fasciocutaneous supramalleolar flap with orthograde blood flow, fasciocutaneous lateral supramalleolar perforator flap with orthograde blood flow, adipofascial lateral supramalleolar flap with orthograde blood flow, lateral fasciocutaneous supramalleolar flap based on the lateral tarsal artery with retrograde blood flow, lateral fasciocutaneous supramalleolar flap based on the anterolateral malleolar artery with retrograde blood flow according to Oberlin.
Postoperative Management:
"Tie over" dressing for grafting site for 5 days (healing of split/full-thickness skin graft), complete immobilization of the lower leg for 7 days in a dorsal plaster splint (ensure that there is no pressure on the flap), progressive increase of range of motion after 1 week, postoperative standardized compression therapy, combined with scar therapy (silicone sheet).
Results:
Reliable, excellent functional and aesthetic results with thin skin in small to midsize defects. Increasing morbidity of grafting site in larger flaps and risk of neuroma when the superficial peroneal nerve was exposed.
