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

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 studied: the 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 times: for skin defects over the ankle (4), foot (16), and leg (7). The distally based sural neurocutaneous flap was used 42 times: over 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 twice: in 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. 107: 383, 2001.)

[1]  Cariou Jl.  [1984-1994: Ten years of skin flaps. Foreword]. , 1995 .

[2]  C. Oberlin,et al.  The Posterolateral Malleolar Flap of the Ankle: A Distally Based Sural Neurocutaneous Flap—Report of 14 Cases , 1995, Plastic and reconstructive surgery.

[3]  S. Torii,et al.  The Distally Based Superficial Sural Artery Flap , 1994, Plastic and reconstructive surgery.

[4]  A. Masquelet,et al.  Skin Island Flaps Supplied by the Vascular Axis of the Sensitive Superficial Nerves: Anatomic Study and Clinical Experience in the Leg , 1992, Plastic and reconstructive surgery.

[5]  R. J. Fix,et al.  Fasciocutaneous flaps in reconstruction of the lower extremity. , 1991, Clinics in plastic surgery.

[6]  C. Argenson,et al.  Extensor Digitorum Brevis as an Island Flap in the Reconstruction of Soft‐Tissue Defects in the Lower Limb , 1989, Plastic and reconstructive surgery.

[7]  C. Gerber,et al.  The lateral supramalleolar flap. , 1988, Plastic and reconstructive surgery.

[8]  Y. Allieu,et al.  [Use of a distal pedicle medial hemisoleus flap in the treatment of residual osteitis of the lower quarter of the leg]. , 1988, Annales de chirurgie plastique et esthetique.

[9]  C. Leclercq,et al.  [Cutaneous cover of the lower third of the leg: the distal soleus muscle flap]. , 1987, Annales de chirurgie plastique et esthetique.

[10]  C. Romana,et al.  [The external supramalleolar flap]. , 1987, Chirurgie; memoires de l'Academie de chirurgie.

[11]  H. Buncke,et al.  The extensor digitorum brevis as a muscle island flap. , 1985, Plastic and reconstructive surgery.

[12]  A. Landi,et al.  The extensor digitorum brevis muscle island flap for soft-tissue loss around the ankle. , 1985, Plastic and reconstructive surgery.

[13]  A. Masquelet,et al.  [The plantar flap in reconstructive surgery of the foot]. , 1984, Presse medicale.

[14]  D. Sharpe,et al.  Cross-leg fasciocutaneous flaps. , 1983 .

[15]  E. Oberto,et al.  Twenty Years’ Experience Using the Cross-Leg Flap Technique , 1982, Annals of plastic surgery.

[16]  J. K. Wright,et al.  Use of the soleus muscle flap to cover part of the distal tibia. , 1981, Plastic and reconstructive surgery.

[17]  D. Harrison,et al.  The instep island flap to resurface plantar defects. , 1981, British journal of plastic surgery.

[18]  P. G. Arnold,et al.  Extensor digitorum turn-down muscle flap. , 1980, Plastic and reconstructive surgery.

[19]  J. McCraw.  Selection of alternative local flaps in the leg and foot. , 1979, Clinics in plastic surgery.

[20]  P. Townsend.  An inferiorly based soleus muscle flap. , 1978, British journal of plastic surgery.

[21]  A. Morris,et al.  The place of the cross-leg flap in reconstructive surgery of the lower leg and foot: a review of 165 cases. , 1978, British journal of plastic surgery.

[22]  S. Medgyesi,et al.  Pedicle muscle flaps and their applications in the surgery of repair. , 1973, British journal of plastic surgery.