The instep flap for anterior ankle coverage with bone and hardware exposure

Area of Science:

• Orthopedic surgery
• Plastic and reconstructive surgery
• Trauma surgery

Background:

• The instep medial plantar flap is typically used for heel defects.
• Its application for anterior ankle defects with exposed bone and hardware after distal tibial fracture fixation is less common.

Purpose of the Study:

• To evaluate the feasibility, viability, and reliability of the instep medial plantar flap for anterior ankle coverage.
• To assess its efficiency in protecting internal fixation devices and promoting bone healing.
• To analyze flap condition, cosmetic appearance, and harvesting-related complications.

Main Methods:

• Retrospective review of patients treated with an instep flap for anterior ankle coverage between December 2015 and December 2020.
• Assessment of flap viability, sensory and functional status, local infection, and toe sensation.
• Evaluation of subjective cosmetic appearance and flap-related morbidity.

Main Results:

• Four patients with a mean age of 32 years and 35 months follow-up.
• All fractures achieved complete consolidation; flaps remained viable, stable, and sensitive.
• No distal sensation disturbance or infection was noted; one patient had a mild aesthetic complaint.

Conclusions:

• The fascio-cutaneous instep medial plantar flap is a reliable and reproducible option for anterior ankle defects up to 9x6 cm.
• It provides good soft tissue coverage, satisfactory cosmetic outcomes, and minimal morbidity.
• This flap is effective in protecting hardware and promoting bone healing in complex distal tibial fractures.