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The distal fibular perforating axial flap for lateral malleolus coverage: an anatomical description and surgical technique

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Abstract

Purpose

Skin closure disorders in ankle surgery are a recurrent problem not only in traumatology but also in elective surgery. The aim of the study was to describe the anatomical basis of the fasciocutaneous vascularization of the lateral malleolus region to develop a posterior cover flap for the region.

Methods

We dissected ten fresh frozen specimens after arterial injection of an Indian ink preparation and individualized the perforating arteries. Their positions and diameters were collated. Then, the surgical technique was clinically applied for two different cases by transferring the fasciocutaneous flap posterior to the lateral malleolus to cover a loss of skin substance.

Results

There were in average 5 fibular perforators over the last 100 mm of the fibula. The average diameter of the first two perforating arteries was 0.6 ± 0.12 mm and 0.9 ± 0.25 mm, respectively, and the consistency of the latter makes it possible to produce a skin flap with anterior translation. This is an axial flap. Two patients were operated on using this technique. There was no necrosis of the posterior fibular flap and healing was achieved by the third post-operative week.

Conclusion

This study showed the presence of fibular perforating arteries with a high reproducibility of their dissection. This anatomical description served as the basis for the description of a new distal fibular perforating flap.

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Funding

The authors declare no funding for this study.

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Authors and Affiliations

  1. Institute of Normal Anatomy, Medical School, 4, rue Kirschleger, 67085, Strasbourg Cedex, France

    Philippe Clavert, Benjamin Puliero & Irène Ollivier

  2. Department of Orthopedic, University Hospital Hautepierre 2, Strasbourg, France

    Philippe Clavert, Benjamin Puliero, David Eichler & François Bonnomet

Authors
  1. Philippe Clavert
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  2. Benjamin Puliero
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  3. David Eichler
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  4. Irène Ollivier
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  5. François Bonnomet
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Contributions

PC: project development, data analysis, manuscript writing. BP: data collection, analysis, and manuscript writing. DE: manuscript editing, data analysis and translation. IO: data collection. FB: manuscript editing.

Corresponding author

Correspondence to Philippe Clavert.

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Conflict of interest

The authors declare no direct conflicts of interest with this study. P. Clavert is a member of SRA Board.

Ethics approval

Not Applicable for the anatomical study. For the clinical part of the study, included patients gave informed consent to participate, and the study obtained ethical committee approval to participate, and for publication.

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Clavert, P., Puliero, B., Eichler, D. et al. The distal fibular perforating axial flap for lateral malleolus coverage: an anatomical description and surgical technique. Surg Radiol Anat 45, 1191–1196 (2023). https://doi.org/10.1007/s00276-023-03204-w

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  • DOI: https://doi.org/10.1007/s00276-023-03204-w

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