J Korean Orthop Assoc.  2010 Aug;45(4):264-272.

Lateral Supramalleolar Adipofascial Flap in Young Children

Affiliations
  • 1Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea. minbom@medimail.co.kr

Abstract

PURPOSE
To report relatively long-term clinical results of lateral supramalleolar adipofascial flap for children who injured soft tissue on the dorsum of the foot and ankle, a condition that readily gives rise to contracture and deformity in that area. MATERIALS AND
METHODS
This report presents the authors' experience with eleven patients treated with this flap. The patients' ages ranged from three to nine years; three of the patients were male and eight were female. The major cause of the soft-tissue defects involved acute crushing injury from a traffic accident. The flap and the adjoining raw area were covered with a full-thickness skin graft after 5-7 days postoperatively, and the donor site at the lateral aspect of the leg was closed primarily without grafting. A skin graft was taken from the groin area, which was closed primarily.
RESULTS
All flaps survived, and there were no major complications. No patients showed contracture at the recipient site or deformity of the foot and ankle. Compared with the other flaps, this adipofascial flap was thinner, produced less bulkiness at the recipient site, and caused only minor aesthetic sequelae at the donor site. None of the patients in this study complained of contracture and limitation of motion of the metatarso-phalangeal joint, which might be disturbed by wearing shoes or walking.
CONCLUSION
The relatively long-term clinical result of a lateral supramalleolar adipofascial flap for children who sustain soft tissue defects on the dorsum of the foot and ankle is satisfactory.

Keyword

dorsum of the foot and ankle; lateral supramalleolar adipofascial flap; reconstruction; children

MeSH Terms

Accidents, Traffic
Animals
Ankle
Child
Congenital Abnormalities
Contracture
Female
Foot
Groin
Humans
Joints
Leg
Male
Shoes
Skin
Tissue Donors
Transplants
Walking

Figure

  • Figure 1 Posttraumatic soft-tissue defect of a 3-year-old girl, with exposure of the medial cuneiform, the first tarsometatarsal joint, the tibialis anterior tendon and the extensor hallucis tendon, and loss of the dorsalis pedis artery and the superficial peroneal nerve.

  • Figure 2 Wound was prepared to be covered with the flap. Big toe and ankle were fixated with K-wire temporally.

  • Figure 3 Design of the lateral supramalleolar adipofascial flap, with its vascular supply from the perforating branch of the peroneal artery. The adipofascial flap was obtained from the same territory as the lateral supramalleolar flap.

  • Figure 4 The overlying skin was dissected at this venous plane.

  • Figure 5 The adipofascial flap was elevated and ready to transfer. The overlying skin and superficial peroneal nerve were preserved.

  • Figure 6 The flap was brought to lateral dorsal side of the foot. Supreficial peroneal nerve and perforating branch of the peroneal artery were observed.

  • Figure 7 The donor site was closed primarily. The flap was transferred through subcutaneous tunnel to cover the defect. The distal area of the donor site was loosely sutured not to choke a pedicle of the flap.

  • Figure 8 This picture shows the flap covering the defect and being sutured.

  • Figure 9 The reconstructed area and donor site, with a good contour and appearance 43 months postoperatively.

  • Figure 10 Note the good range of motion of the ankle joint.


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