DELAYED SUPRAMALLEOLAR FLAP – AN INNOVATIVE TECHNIQUE FOR ENHANCED VIABILITY
AbstractBackground: Delaying flap rotation for 48 to 72 hours leads to opening of choke anastomoticvessels linking adjacent vascular territories. This mechanism enhances flap circulation. Lateralsupramalleolar flap with larger dimensions or vascular variations can potentially have survivalproblems. The purpose of this study is to assess the outcome of delayed lateral supramalleolarflap. Methods: This descriptive case series was conducted at Aga Khan University Hospital,Karachi from May 1999 to December 2004. Eight cases of delayed lateral supramalleolar flapwere identified through medical records maintained through Health Information ManagementSystems (HIMS). A detailed questionnaire was developed addressing variables of interest.Results: Eight patients required flap delay for 48 hours out of 25 patients, who underwent lateralsupramalleolar flap for coverage of foot and ankle soft tissue defects. There were six male (75%)and two female (25%) patients with average age of 31.25 years ranging from 5-52. The reasons fordelaying lateral supramalleolar flap were larger flap dimension in four (50%), absent peronealartery perforator in three (37.5%) and one patient (12.5%) had poor circulation in immediatepostoperative period. All the patients required two stage procedure and had excellent coverage ofdefects. No flap failure occurred subsequent to the delay procedure. Conclusions: Flap delayenhanced survival and extended the viable dimensions of lateral supramalleolar flap.Compromised circulation in larger flaps and flaps with vascular variations can be improved bydelaying flap transfer to the recipient site for 48 hours following its elevation.Keywords: Delayed flap, Lateral supramalleolar flap, Foot and ankle soft tissue defects.
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