Medial triceps brachii free flap in reconstructive surgery: a prospective study in eight patients

In this study, we present a prospective series of medial triceps free flaps for ankle and foot complex defects coverage and discuss its numerous advantages.

Between January 2011 and December 2012, eight patients, two women and six men underwent medial triceps brachii (MTB) free flap procedure to cover defects localized at the ankle and foot in our department. Patient mean age was 37.3 ± 15.2 years at the time of surgery (range of 13-53 years). Mean defect size to be covered was 21.8 ± 9.9 cm(2). The bone was exposed at the level of the calcaneum in six cases, at the level of the forefoot in one case, and at the level of the lateral malleolus in one case. Special attention was accorded to intra-operative findings. Flap survival and complications on both the donor and recipient site were prospectively evaluated.

Mean MTB flap raising time was 51.3 ± 6.0 min. All the flaps survived and there was no partial flap necrosis. A skin graft was performed after a mean time of 11.8 ± 2.1 days post-operative. The mean follow-up was 18.1 ± 3.8 months. Complications at the donor site level included one hematoma and a case of hypertrophic scar. Complete healing of both the donor and recipient sites was achieved in all cases.

MTB free flap appears to be a useful option for covering small to medium defects in lower limb extremities. Due to the constant anatomy of the MTB nerve, we suggest that the flap could also be used as an innervated free flap for small or medium muscular reanimation such as sequelae of forearm and hand muscle impairment, or facial palsy.