Voche Philippe, Merle Michel, Stussi Jean-David
European Institute for Hand Surgery, Maxeville, France.
Ann Plast Surg. 2005 Jan;54(1):49-54. doi: 10.1097/01.sap.0000139565.36738.b3.
The lateral supramalleolar flap was used in 41 cases of distal third of the leg, foot, ankle, and heel skin defect reconstruction. The arterial blood supply was mixed in 33 cases and retrograde in 8 cases. The authors recommend raising a distal subcutaneous pedicle to avoid skin grafting over the tendons. In main cases of mixed blood supply, the superficial peroneal nerve could be spared. Eight venous congestions were observed, including 3 with partial flap necrosis. The plastic result was assessed as satisfactory in all but 2 patients. The cosmetic aspect was satisfactory in only 6 patients. Donor site morbidity was minimal, while cosmetic results were assessed as satisfactory in all but 2 patients. The main local alternative was the distally based sural flap, which is technically less demanding. Except for the distal coverage of the foot, indications for both flaps are similar. The distally based sural flap requires the sural nerve to be divided and does not cover as distally as the lateral supramalleolar flap.
外踝上皮瓣用于41例小腿远端、足部、踝部及足跟皮肤缺损的修复。33例为混合血供，8例为逆行血供。作者建议掀起远端皮下蒂以避免在肌腱上植皮。在混合血供的主要病例中，腓浅神经可予保留。观察到8例静脉淤血，其中3例伴有部分皮瓣坏死。除2例患者外，所有患者的整形效果评估为满意。仅6例患者的美容效果满意。供区并发症极少，除2例患者外，所有患者的美容效果评估为满意。主要的局部替代皮瓣是远端蒂腓肠神经营营皮瓣，其技术要求较低。除足部远端覆盖外，两种皮瓣的适应证相似。远端蒂腓肠神经营营皮瓣需要切断腓肠神经，且覆盖范围不如外踝上皮瓣远。
