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.
Yoshimura M, Shimada T, Imura S, Shimamura K,
Yamauchi S. Peroneal island flap for skin defects in the
lower extremity. J Bone Joint Surg Am 1985;67(6):935-41.
Masquelet AC, Beveridge J, Romana C, Gerber C. The
lateral supramalleolar flap. Plast Reconstr Surg
Leung PC, Hung LK, Leung KS. Use of the medial plantar
flap in soft tissue replacement around the heel region. Foot
Menesi L. [The lateral supramalleolar fasciocutaneous flap
and its modification]. Magy Traumatol Ortop Kezseb
Plasztikai Seb 1994;37(4):371-4.
Valenti P, Masquelet AC, Romana C, Nordin JY. Technical
refinement of the lateral supramalleolar flap. Br J Plast Surg
Nohira K, Shintomi Y, Sugihara T, Ohura T. Replacing
losses in kind: improved sensation following heel
reconstruction using the free instep flap. J Reconstr
Saitoh S, Hata Y, Murakami N, Seki H, Kobayashi H,
Shimizu T, et al. The 'superficial' peroneal artery: a variation
in cutaneous branching from the peroneal artery, nourishing
the distal third of the leg. Br J Plast Surg 2001;54(5):428-33.
Wolff KD. The supramalleolar flap based on septocutaneous
perforators from the peroneal vessels for intraoral soft tissue
replacement. Br J Plast Surg 1993;46(2):151-5.
Beveridge J, Masquelet AC, Romana MC, Vinh TS.
Anatomic basis of a fascio-cutaneous flap supplied by the
perforating branch of the peroneal artery. Surg Radiol Anat
Cormack GC, Lamberty BG. A classification of fasciocutaneous flaps according to their patterns of vascularisation.
Br J Plast Surg 1984;37(1):80-7.
Whetzel TP, Barnard MA, Stokes RB. Arterial
fasciocutaneous vascular territories of the lower leg. Plast
Reconstr Surg 1997;100(5):1172-85.
Dhar SC, Taylor GI. The delay phenomenon: the story
unfolds. Plast Reconstr Surg 1999;104(7):2079-91.
Morris SF, Taylor GI. The time sequence of the delay
phenomenon: when is a surgical delay effective? An
experimental study. Plast Reconstr Surg 1995;95(3):526-33.
Bevan JA. Shear stress, the endothelium and the balance
between flow-induced contraction and dilation in animals and
man. Int J Microcirc Clin Exp 1997;17(5):248-56.
JD. C. endothelial regulation of vascular tone. Hosp Pract
Seify H, Bilkay U, Jones G. Improvement of TRAM flap
viability using human VEGF-induced angiogenesis: a
comparative study of delay techniques. Plast Reconstr Surg
Erdmann D SB, Moquin KJ, Young H, Georigiade GS. Delay
in unpedicled TRAM flap for reconstruction of breast. Plast
Reconstr Surg 2002;110:762-67.
Jensen JA. Tram flap delay: two techniques and an
unresolved question. Plast Reconstr Surg 2003;111(7):2478-
Okazaki M, Ueda K, Kuriki K. Lateral supramalleolar flap
for heel coverage in a patient with Werner's syndrome. Ann
Plast Surg 1998;41(3):307-10.
Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS,
Germann GK. A realistic complication analysis of 70 sural
artery flaps in a multimorbid patient group. Plast Reconstr
Surg 2003;112(1):129-40; discussion 141-2.
Finseth F, Cutting C. An experimental neurovascular island
skin flap for the study of the delay phenomenon. Plast
Reconstr Surg 1978;61(3):412-20.
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