TECHNICAL OF PIVOT POINT SELECTION FOR RETROGRADE LATERAL SUPRAMALLEOLAR FLAP

Ngoc Thach Nguyen1, Trong Tuong Mai1, Thi Cao2,
1 Hospital for Traumatology and Orthopaedics
2 University of Medicine and Pharmacy at Ho Chi Minh City

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Abstract

Background: Retrograde lateral supramalleolar flap is used to cover soft tissue defects at the ankle and foot. There is no article that suggests the pivot point of this flap to support clinical surgeons in designing the flap preoperative aim to estimate this option's feasibility. Objectives: Determining the pivot point based on the anastomosis between the descending branch with the anterolateral malleolar artery and the anastomosis between the anterolateral malleolar artery and the anterior tibia artery. Materials and methods: 24 fresh amputated legs. Case series study. This research was conducted from Jan 2020 to Dec 2022 at the microsurgery laboratory of Hospital for Traumatology and Orthopedic, Ho Chi Minh City. Gathered information about the location of anastomosis points and the total length of the flap. Results: There has been the existence of vessel anastomosis to supply retrograde blood flow to the lateral supra malleolar flap. The mean total length of a flap from the anastomosis point between the descending branch with anterolateral malleolar artery was 19.5 cm, from the anastomosis point between the anterolateral malleolar artery with the anterior tibia artery was 21.9 cm. Conclusion: Retrograde lateral supramalleolar flap is nourished by the anastomosis between the descending branch with anterolateral artery and anterolateral artery with anterior tibia artery. The maximum total length of a flap is 30 cm, as the pivot point is based on the anastomosis of the anterolateral malleolar artery with the anterior tibia artery.

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References

1. Hashmi P. M., Ahmed K, Ali M, et al. Lateral supramalleolar flap: Is it based on perforator of peroneal/anterior tibial artery; A cross-sectional study at tertiary care centre. Annals of medicine and surgery. 2021. 71, 102916, doi:10.1016/j.amsu.2021.102916.
2. Mehmood Hashmi P., Musaddiq A., Hashmi A., et al. Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients. Annals of medicine and surgery (2012). Jan 2022. 73, 103-109, doi:10.1016/j.amsu.2021.103109.
3. Nambi G. I., Varanambigai T. K. A. Clinical Study of the Lateral Supramalleolar Flap in the Soft Tissue Reconstruction around the Ankle Region. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India. Mar 2020. 53(1), 83-89, doi:10.1055/s-0039-3402354.
4. Li P., Zhang H., Zhu J., et al. Foot and ankle reconstruction using the lateral supramalleolar flap versus the anterolateral thigh flap in the elderly: A comparative study. International wound journal. Oct 2022. 19(6), 1518-1527. doi:10.1111/iwj.13751.
5. Lee J. H., Chung D. W. Reverse lateral supramalleolar adipofascial flap and skin grafting for one-stage soft tissue reconstruction of foot and ankle joint. Microsurgery. Sep 2010. 30(6), 423429, doi:10.1002/micr.20762.
6. Masquelet A. C. , Beveridge J., Romana C., et al. The lateral supramalleolar flap. Plastic and reconstructive surgery. Jan 1988. 81(1), 74-81, doi:10.1097/00006534-198801000-00014.
7. Beveridge J., Masquelet A. C., Romana M. C., et al. Anatomic basis of a fascio-cutaneous flap supplied by the perforating branch of the peroneal artery. Surgical and radiologic anatomy : SRA. 1988. 10(3), 195-9, doi:10.1007/bf02115236.
8. Mai Trọng Tường. Khảo sát giải phẫu cuống mạch đầu xa đảo da cân thần kinh hiển ngoài và các cải tiến lâm sàng. Luận án tiến sĩ Y học. Đại học Y Dược thành phố Hồ Chí Minh. 2012.
9. Masquelet A. C. Transfers from the lower limb. An Atlas of Flaps of the Musculoskeletal System. 1st ed. 2001.
10. Le Nen D., Beal D., Person H., et al. Anatomical basis of a fascio-cutaneous pedicle flap based on the infero-lateral collateral artery of the leg. Surgical and radiologic anatomy : SRA. 1994. 16(1), 3-8, discussion 9, doi:10.1007/bf01627913.
11. Nguyễn Tiến Bình. Nghiên cứu giải phẫu vạt da cân trên mắt cá ngoài, vạt bắp chân cuống ngoại vi và ứng dụng điều trị khuyết hổng phần mềm đoạn 2/3 dưới cẳng chân, cổ chân. Luận án tiến sĩ khoa học y dược. Học viện Quân Y Hà Nội. 1997.
12. Mai Trọng Tường. Khảo sát giải phẫu: Các dạng biến đổi của cuống mạch vạt da trên mắt cá ngoài. Y học TP Hồ Chí Minh. 2003. 7(1), 31-35.
13. Rong K., Chen C., Hao L. W., et al. Redefining the Vascular Classifications of the Lateral Supramalleolar Flap. Annals of plastic surgery. Sep 2016. 77(3), 341-4, doi:10.1097/sap.0000000000000576.