Medial and Lateral Malleolar Perforator Flaps for Repair of Defects Around the Ankle

Abstract

In Brief Reconstruction for defects around the ankle continues to be challenging. Repairs have been effected with the dorsalis pedis flap, the medial plantar flap, and with reverse-flow island flaps using the anterior and posterior tibial systems and the peroneal system. However, sacrifice of the major vessels of the lower leg and wide and long scars at the donor site are disadvantages of these flaps. To overcome these disadvantages, the authors developed island lateral and medial malleolar flaps with the perforators located close to the ankle. These flaps are easy to elevate, involve a short operating time, require no sacrifice of major vessels or muscles of the lower legs, and the use of these adipofascial flaps makes donor scars more acceptable. Malleolar perforator flaps are suitable for the repair of small ankle defects. Ten patients with intractable ankle and heel defects were repaired using island medial and lateral malleolar flaps with two distal flap losses and no amputations. Injection cadaver studies demonstrated consistent perforating arteries around the malleoli from all three major leg vessels.