FASICOCUTANEOUS AND MUSCLE FLAPS FOR TISSUE DEFECTS INVOLVING THE ANKLE: 22 CASES

Abstract

Purpose of the study: The thin soft tissue cover and the proximity of underlying structures of the ankle are factors favoring cutaneous necrosis which could rapidly expose the bone, joint or tendons. Flap cover is widely used. Several types of flap and donor sits have been described. We report a consecutive series to examine the different indications.

Material and methods: Between 2000 and 2005, we treated 22 cases of tissue defects involving the ankle. Most patients were trauma victims with damage involving the distal quarter of the leg to the forefoot. Mean size of tissue loss was 8 x 6 cm (range 2–13 x 2–9 cm). The localization was medial for nine, anterior for six, and lateral for seven. Several types of flaps were used: distally-based sural (n10), lateral supramaleolar (n=5), medial arch (n=2), pediculated soleus (n=4), island latissimus dorsi (n=1).

Results: The success rate was 72%. There was one total failure (medial arch). The six cases of partial failure (27%), which involved partial distal necrosis of three lateral supramaleolar flaps and three sural flaps, were revised by re-advancement of the pedicle or aspirative dressings.

Discussion: When possible, we prefer pediculated flaps considered to be more reliable. The rate of partial necrosis was high but all of the failure cases involved serious general problems. The sural flap is especially useful for anterior and lateral tissue defects. Its deep pedicle is often intact, improving chances of survival. It can also be used for transverse anteriomedial injuries. Large longitudinal medial defects would be a good indication for free flaps or, in the event of a contraindication and also, in our experience, for pediculated soleus flaps. Supramalleolar flaps can be a problem in this localization: we reserve these flaps for non-traumatic medial or anterior defects. We have found that the risk of failure it too great for the medial supramalleolar flap.