Anterior Supramalleolar Perforator Flap

, Shimin Chang², Jian Lin³ and Dajiang Song¹

(1)

Department of Orthopedic Surgery, Changzheng Hospital Second Military Medical University, Shanghai, China

(2)

Department of Orthopedic Surgery, Yangpu Hospital Tongji University School of Medicine, Shanghai, China

(3)

Department of Microsurgery, Xinhu Hospital Shanghai Jiao Tong University, Shanghai, China

The anterior supramalleolar perforator flap is pedicled on the superior malleolar cutaneous branch of the anterior tibial artery. It is a fasciocutaneous flap located in the middle-distal third of the lower leg.

A variant of adipofacial flaps based on perforators of the distal anterior tibial artery have been used to cover complex ankle defects [1, 2].

28.1 Vascular Anatomy

Anatomic dissections of cadaveric legs demonstrated a constant dominant perforator located 3.5 cm above the line between the medial malleolus and lateral malleolus. There was no significant branching pattern variability noted, except at the subdermal level (Fig. 28.1).

Fig. 28.1

Vascular anatomy of the anterior supramalleolar perforator flap

28.2 Illustrative Case

A 45-year-old male suffered a traffic accident over his right dorsal foot, resulting in skin and soft tissue defect, with exposure of the dorsal bones and tendons (Fig. 28.2).

Fig. 28.2

Preoperative view

Flap Design

The wound was covered with a distally pedicled flap based on anterior tibial artery perforators.

A handheld ultrasound Doppler scanner was used preoperatively to detect perforator arteries around the donor-site area, and a free-style perforator flap was used (Fig. 28.3

Only gold members can continue reading. Log In or Register to continue