Lateral supramalleolar flap for soft-tissue coverage of ankle and foot defects

The reconstruction of soft tissue defects in the foot and ankle remains a big challenge due to the anatomical characteristics of this area. This study evaluated the long-term effectiveness of covering by lateral supramalleolar flap in patients with soft tissue defects around the ankle and foot. We conducted a retrospective study from January 2017 to December 2020 at the Hospital for Traumatology and Orthopedics, Ho Chi Minh City, Vietnam. Data about patients' characteristics, detailed injuries, perioperative information, intraprocedural dossier, and complications of this method were recorded and analyzed. There were 31 male and 17 female patients, with an average age of 39.8 (ranging from 11 to 77) years. The skin defects ranged from 8 cm² to 120 cm². The blood supply for the flap included a mixed-flow pattern (n = 30) and retrograde flow (n = 18). The success rate was 94%. Forty-two patients had been successfully covered, five patients had partial flap necrosis (in which two cases needed skin graft afterwards and three cases got spontaneous healing), only one patient had total flap necrosis. In conclusion, the lateral supramalleolar flap can cover the soft tissue of ankle and foot defects in both mixed-blood supply pattern or retrograde pattern with high success rates. However, the risk of venous congestion should be considered, particularly when using the retrograde pattern flap.