The lateral supramalleolar flap for the treatment of open foot and ankle fractures

Abstract

The purpose of this study is to describe the efficacy of lateral supramalleolar flap as an option for soft tissue repair in open fractures of foot and ankle and to present the experience in 2 trauma units: Hospital Susana López de Valencia, Popayán Colombia, and Hospital Universitario de Santander, Bucaramanga Colombia. This is an observational, case series study including all patients with open fractures of foot and ankle who were treated from January 2016 to June 2021 and who required soft tissue coverage. Patients whose soft tissue injury was located on the anatomical area of the perforating peroneal artery, those with less than 6 months of follow-up and those who refused the proposed treatment were excluded. On the other hand, although literature reports flaps of up to 100 cm 2 [1], in our hands, this flap unsuitable for skin defects larger than 60 cm 2 , and other procedures such as free flaps should be considered in these cases. Thirteen patients were selected, 9 men and 4 women, with a mean age of 30 years (12–62 years) and mean follow-up duration of 10.3 months [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. In 11 patients, the mechanism of trauma involved a motorcycle accident. Mean flap size was 40 cm 2 (30–48 cm 2 ). Ten flaps survived with no acute problems, 2 presented with venous congestion and epidermolysis, which were treated conservatively, and 1 developed complete necrosis requiring reintervention. All interventions were performed by the authors belonging to the orthopedic trauma units from the involved hospitals. The lateral supramalleolar flap is an excellent alternative for the treatment of coverage defects caused by open foot and ankle fractures, producing satisfactory and predictable results in the hands of orthopedic surgeons with no specific training in microsurgical techniques. Level of clinical evidence: 4. • The treatment of open distal tibial, ankle, and foot fractures, represents a significant challenge, and it needs early coverage. • Microvascular techniques and free flaps are demanding procedures not always available in trauma centers. • The supramalleolar flap is a reproducible option for soft tissue coverage in distal tibial, ankle, and open foot fractures.