"Pure Fat Flap"-Perforator-based Adiposal Layer Only Flap for Lateral Ankle Reconstruction

Area of Science:

• Microsurgery
• Orthopedic Surgery
• Plastic Surgery

Background:

• Lateral ankle soft tissue defects present significant reconstructive challenges.
• Chronic pressure and open joints complicate defect management.
• Traditional fasciocutaneous flaps can lead to donor site morbidity.

Purpose of the Study:

• To present a case of diabetes-related lateral ankle defect reconstruction.
• To evaluate the efficacy of an adiposal layer only flap (pure fat flap).
• To review the anatomy and surgical technique of this flap for ankle coverage.

Main Methods:

• A perforator-based adiposal layer only flap was elevated from the peroneal artery.
• Flap perfusion was confirmed using indocyanine green video angiography and color duplex ultrasound.
• The flap was used to cover a complex lateral ankle defect.

Main Results:

• Successful reconstruction of the lateral ankle defect was achieved.
• The pure fat flap effectively obliterated dead space and provided a gliding surface.
• The patient experienced a successful recovery with minimal donor site morbidity.

Conclusions:

• The adiposal layer only flap is a viable option for complex lateral ankle soft tissue defects.
• This technique preserves subdermal plexus and deep fascia, enhancing functional outcomes.
• It expands reconstructive microsurgical options for challenging ankle coverage cases.