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Reconstruction with local fasciocutaneous flaps of soft tissue defects resulting from malleolar fractures

Eyup Cagatay Zengin, Hakan Ertem, Sertac Saruhan, Cumhur Davulcu, Muhittin Sener.

Abstract
Objectives: Soft tissue defects of the ankle malleolar region may develop after a traumatic injury or the surgery required to repair this trauma. The aim of this study is to evaluate the results of the flaps used to repair soft tissue defects after medial and lateral malleolar fractures of the ankle.
Methods and Materials: Patients who were treated with flaps due to soft tissue defect after surgical treatment of malleolar fractures between 2010-2018 were evaluated retrospectively. Of the patients included in the study, six (24%) were female and 19 (76%) were male. The mean age was 50.4 years (range of 5-83 years). All patients had a soft tissue defect with an exposed tendon, joint, bone, or implant either isolated or in combination. At the last follow-up, the patients were evaluated for the viability of the flap, complications, and patient satisfaction.
Results: Seventeen (68%) of the patients had a reverse-sural fasciocutaneous flap (RSFF), 7 (28%) had rotational flaps, and 1 (4%) had a propeller flap. The size of the flaps ranged from 6 x 9 cm to 2 x 2 cm (mean 4.3 ± 1.7 x 3.9 ± 1.3). The mean follow-up period was 22 months (range of 6-35 months). The mean time of flap application after the trauma was 40 days (range of 10-150 days). Marginal skin necrosis developed in two patients with rotational flaps. Partial necrosis due to venous congestion developed in four patients with RSFF. These patients were treated successfully with skin grafting in addition to debridement. There was no complete flap loss.
Conclusion: Rotational and RSFF can be applied effectively without the need for microsurgery, anticoagulant therapy, or monitoring. Both of flaps can be applied safely, quickly and easily for reconstruction of soft tissue defects resulting from malleolar fractures.

Key words: Ankle fractures, local flaps, reconstructive surgical procedures


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