Comparative Study of Two Series of Distally Based Fasciocutaneous Flaps for Coverage of the Lower One-Fourth of the Leg, the Ankle, and the Foot

• Published in: Plastic and reconstructive surgery (1963) Vol. 107; no. 2; pp. 383 - 392
• Main Authors: Touam, C, Rostoucher, P, Bhatia, A, Oberlin, C, Touam, Chabane
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Society of Plastic Surgeons 01-02-2001; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Ankle Injuries - surgery; Biological and medical sciences; Cellulitis - surgery; Female; Follow-Up Studies; Humans; Leg Injuries - surgery; Male; Medical sciences; Microsurgery; Middle Aged; Nerve Regeneration - physiology; Pain Threshold - physiology; Postoperative Complications - physiopathology; Skin plastic surgery; Soft Tissue Injuries - surgery; Soft Tissue Neoplasms - surgery; Sural Nerve - physiopathology; Sural Nerve - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps - innervation; Human; Reconstruction; Fasciocutaneous flap; Lower limb; Plastic surgery; Resurfacing; Leg; Foot; Result; Ankle; Treatment; Surgery; Distal; Technique; Comparative study
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/00006534-200102000-00013

Skin defects over the lower one-fourth of the leg and over the foot are difficult to cover. Two types of pedicled fasciocutaneous flaps used to cover such defects were studiedthe lateral supramalleolar flap and the distally based sural neurocutaneous flap. The series consisted of 27 and 36 cases, respectively. The lateral supramalleolar flap was used 27 timesfor skin defects over the ankle (4), foot (16), and leg (7). The distally based sural neurocutaneous flap was used 42 timesover the foot (24), ankle (13), and leg (5). Fourteen of these patients were 65 years of age or older, and local vascularity was diminished in 16 cases. The flaps were evaluated clinically twicein the immediate postoperative period for survival or for partial or total flap necrosis, and again to determine the presence of pain at the donor or recipient sites and the cosmetic appearance. Thirty-nine patients (62 percent) were reviewed subsequently, with a mean follow-up of 5 years for the supramalleolar flap and 2 years for the sural neurocutaneous flap. The results were evaluated for the presence or absence of pain, the appearance of the flap, the disability due to the insensate nature of the flap, and the presence or absence of secondary ulceration. Painful neuromata were noted in three cases with the sural neurocutaneous flap, whereas complete necrosis of the supramalleolar artery flap occurred in three patients. The distally based sural neurocutaneous island flap is very reliable, even in debilitated patients. Though the lateral supramalleolar artery flap offers the possibility of covering the same areas as the sural neurocutaneous flap, it is much less reliable in the presence of diminished local vascularity (18.5 percent failure rate as compared with 4.8 percent for the sural neurocutaneous flap). Because the procedure can cover extensive defects and is easy to perform, the distally based sural neurocutaneous flap was the method of choice for covering skin defects over the foot, heel, ankle, and the lower one-fourth of the leg. The lateral supramalleolar artery flap is indicated only when the sural neurocutaneous flap is contraindicated. (Plast. Reconstr. Surg. 107383, 2001.)