Long term clinical and functional outcome of lateral supramalleolar flap for soft tissue coverage of foot and ankle defects: Largest case series at a tertiary care hospital

Document Type



Orthopaedic Surgery; School of Nursing and Midwifery, Pakistan


Background: Reconstruction of defects around foot and ankle is challenging issue. We wanted to assess the clinical and functional outcome of lateral supramalleolar flap for coverage soft tissue defects around the foot and ankle. Methods: This analytic case series was conducted at Aga Khan University Hospital, Karachi. The data was collected from medical records and patient interviewing. Patients with soft tissue defects around foot and ankle and coverage with supramalleolar flaps were included. The various parameters of interest (causes, flaps dimensions, vascular variations, and outcome) were included in the prestructured proforma the data was analyzed with SPSS version 25.
Results: Forty-seven patients were included in the study from May 1999 to December 2019. The male to female ratio was 35:12. The mechanism of injury was varied. Eighteen cases were pedicle island flaps whereas two were peninsular rotation flaps. The maximum flap size harvested was 20 cm × 8 cm distal flap necrosis occurred in one patient requiring split thickness skin graft. In eight patients’ flap was rotated as ‘delay flap’. In 12 cases the peroneal artery perforator was absent, the flap being based on inferolateral collateral artery from anterior tibial artery. Majority of the patients fall in excellent category based on self-designed assessment tool. Conclusion: The lateral supramalleolar flap provided coverage to almost all regions of the foot and ankle with a cosmetically acceptable donor and recipient site. There were no problems with shoe wear, only two patients requiring defattening for cosmetic reasons. Microvascular expertise was required for a predictable outcome.


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Publication (Name of Journal)

Clinics in Surgery