Evaluation of Medial and Lateral Supramalleolar Flaps for Reconstruction of Soft Tissue Defects around Ankle

Authors

1 Al-Azhar University Resident of Plastic and Reconstructive Surgery, at Nasser Institute Hospital

2 Professor of Plastic and ReconstructiveSurgery Faculty of Medicine for Boys, Al-Azhar University

3 Professor and Head of Department of Plastic and Reconstructive Surgery Faculty of Medicine for Girls, Al-Azhar University

4 Plastic and Reconstructive Surgery Faculty of Medicine, Helwan University

Abstract

Background: In patients with underlying vascular disease, which can affect circulation, and in patients with chronic wounds brought on by severe trauma, plastic surgeons continue to struggle with the reconstruction of ankle and heel deformities. Due to their capacity to cover soft tissue defects in the lower limb without the need for microsurgical procedures and with reduced donor site morbidity, perforator-based propeller flaps have grown in popularity. Perforator-based propeller flaps were one of the first options for covering lower limb soft tissue defects, due to the idea of replacing "like with like" tissue. Aim of the Work: to evaluate clinically the use of perforator propeller flaps (medial and lateral supramalleoular perforator flaps) for reconstruction of soft tissue defects around the ankle. Patients and Methods: A retrospective study of 20 patients with soft-tissue defects involved acute trauma, chronic scar contracture, and chronic ulcers around the ankle. Reconstruction using medial and lateral supramalleolar perforator-based propeller flaps was conducted between January 2021 and December 2022. Results: The soft tissue defects in our patients ranged from medium-sized to relatively large sized defects, and we were able to successfully use propeller-based perforator flaps to cover the defects with grafting of the donor site. The smallest defect in our study measured 7 x 6 cm, and the largest was 30 x 8 cm. The flap size in our study was measured as well. They ranged from 14x9 cm being the smallest to 30x10 cm being the largest. The outcome was divided into three types: satisfied, borderline, and unsatisfied. Thirteen patients (65%) were satisfied, six patients (30%) were borderline, and one patient was unsatisfied (5%). In four patients who experienced venous congestion, complications were found. Conclusions: Propeller flaps with perforator bases are a significant addition to the toolbox for soft tissue reconstruction. The procedure takes less time and has lower donor site morbidity. The method is perfect for treating small to medium-sized ankle defects.

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