Comparative study of two series of distally based fasciocutaneous flaps for coverage of the lower one-fourth of the leg, the ankle, and the foot

Skill defects over the lower one-fourth of the leg and over the foot are di fficult to cover. Two types of pedicled fasciocutaneous flaps used to cover such defects were studied: the lateral supramalleolar flap and the distall y based sural neurocutaneous nap. The series consisted of 27 and 36 cases, respectively. The lateral supramalleolar nap was used 27 times: for skin de fects over the ankle (4), foot (16), and leg (7). The distally based sural neurocutaneous flap was used 42 times: over the foot (24), ankle (13), and leg (5). Fourteen of these patients were 65 years of age or older, and loca l vascularity was diminished in 16 cases. The flaps were evaluated clinical ly twice: in the immediate postoperative period for survival or for partial or total flap necrosis, and again to determine the presence of pain at the donor or recipient sites and the cosmetic appearance. Thirty-nine patients (62 percent) were reviewed subsequently, with a mean follow-up of 5 years for the supramalleolar flap and 2 years for the sural neurocutaneous flap. The results were evaluated for the presence or absence of pain, the appeara nce of the flap, the disability due to the insensate nature of the flap, an d the presence or absence of secondary ulceration. Painful neuromata were n oted in three cases with the sural neurocutaneous flap, whereas complete ne crosis of the supramalleolar artery flap occurred in three patients. The di stally based sural neurocutaneous island flap is very reliable, even in deb ilitated patients. Though the lateral supramalleolar artery flap offers the possibility of covering the same areas as the sural neurocutaneous flap, i t is much less reliable in the presence of diminished local vascularity (18 .5 percent failure rate as compared with 4.8 percent for the sural neurocut aneous nap). Because the procedure can cover extensive defects and is easy to perform, the distally based sural neurocutaneous nap was the method of c hoice for covering skill defects over the fool, heel, ankle, and the lower one-fourth of the leg. The lateral supramalleolar artery flap is indicated only when the sural neurocutaneous flap is contraindicated.