Lateral supramalleolar flap in reconstruction of pressure ulcers in patients with spinal cord injury.

Pressure ulcers are a major source of morbidity in patients with spinal cord injury. Soft tissue reconstruction of pressure ulcers around the lateral malleolar region continues to be a challenge. Numerous techniques have been described in the published reports, each with their own limitations. We review our clinical experience with the lateral supramalleolar flap for reconstruction of difficult lateral malleolar pressure ulcers in patients with spinal cord injury. This study is a retrospective review of all patients who underwent this procedure between 1991 and 2005. This fasciocutaneous flap is raised on a peroneal artery perforator as its pedicle, without compromising the three vessels supplying the foot. A split-skin graft is placed on the secondary defect. The patient remains in bed for 4-6 weeks before mobilization is allowed. Eight flaps on seven patients were carried out over the study period. Patients' age ranged from 37 to 67 years (mean 56.6 years). Three patients had procedures carried out on the right and three had on the left. One patient had bilateral procedures. All flaps survived, and there were no recurrences of the pressure areas. One patient had a small area of wound breakdown at the edge of the flap, requiring debridement and split-skin graft. Another patient developed a seroma under the split-skin graft over the secondary defect, which resolved with dressings. The lateral supramalleolar flap is a simple, safe and durable flap for lateral malleolar pressure ulcer reconstruction in patients with spinal cord injury.