Efficacy of Locoregional Perforator Flaps for Resurfacing of Peri-ankle Soft Tissue Defects: A Single Centre Prospective Cohort Study

Abstract

Introduction: The foot and ankle serve as vital components in supporting mobility. When afflicted by trauma, infections, burns, or tumours, they often present challenging defects that expose tendons, bones, joints, and nerves. Managing softtissue reconstruction in this area is complex, primarily due to limited local tissue resources and inadequate muscle coverage. A range of reconstructive options exists, encompassing local, locoregional, and distant flaps, with microvascular free flaps as the gold standard. Recent studies have explored newer pedicled and perforator-based flaps as promising alternatives for lower extremity soft-tissue defects. Aim: To explore the efficacy of perforator-based local and locoregional flaps for resurfacing peri-ankle defects. Materials and Methods: This prospective cohort study was conducted at the Department of Plastic Surgery, SSKM Hospital, and IPGME&R, Kolkata, West Bengal, India, from April 2019 to March 2022. A total of 49 patients with soft-tissue defects around the ankle were included. The reconstructive approach primarily involved perforator-based flaps from various arterial sources. Outcomes were categorised as complete defect coverage, minor flap necrosis without intervention, or major necrosis necessitating additional surgical intervention. For this descriptive study, proportion was used to compare categorical variables such as the number of cases with different aetiology, and the number of different flaps used were compared. For the continuous variable like age, mean has been used as a measure of central tendency. Results: The mean age of the study population was 39.6±4.1 years. Thirty-four out of 49 patients (69.38%) presented with defects stemming from Road Traffic Accidents (RTA), and the posterior aspect of the ankle was the most common defect location (14 out of 49 patients, 28.57%). Peroneal Artery Perforator Flaps (PAPF) exhibited the highest success rate, with 18 out of 20 cases where this flap was used (90%), closely followed by Lateral Supramalleolar Flaps (LSF), with 13 out of 15 cases (86.7%). Overall, in 42 out of 49 cases (85.7%), the perforator-based flaps effectively resurfaced the defects. Conclusion: Pedicled perforator-based flaps, including those based on the peroneal artery and lateral supramalleolar, have emerged as valuable options for the reconstruction of softtissue defects around the ankle.