Lateral Supramalleolar Adipofascial Flap in Young Children / 대한정형외과학회잡지

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.

One-stage Reverse Lateral Supramalleolar Adipofascial flap for Soft Tissue Reconstruction of the Foot and Ankle Joint

PURPOSE: To report the clinical results and efficacies of one stage reverse lateral supramalleolar adipofascial flap for soft tissue reconstruction of the foot and ankle joint. MATERIAL AND METHODS: We performed 5 cases of one stage reverse lateral supramalleolar adipofascial flap from Jan 2005 to Sept 2005. All patients were males and mean age was 50(36~59) years old. The causes of soft tissue defects were 1 diabetic foot, 2 crushing injuries of the foot, 1 open fracture of the calcaneus, and 1 chronic osteomyelitis of the medial cuneiform bone. Average size of the flap was 3.6(3~4)x4.6(4~6) cm. All flaps were harvested as adipofascial flap and were performed with the split-thickness skin grafts (STSG) above the flaps simultaneously. RESULTS: All flap survived completely and good taking of STSG on the flap was achieved in all cases. There were no venous congestion and marginal necrosis of the flap. In diabetic foot case, wound was healed at 4 weeks after surgery due to wound infection. There was no contracture on the grafted sites. Ankle and toe motion were not restricted at last follow up. All patients did not have difficulty in wearing shoes. CONCLUSION: The reverse lateral supramalleolar adipofascial flap and STSG offers a valuable option for repair of exposure of the tendon and bone around the ankle and foot. Also one stage procedure with STSG can give more advantages than second stage with FTSG, such as good and fast take-up, early ambulation and physical therapy, and good functional result.