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CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2267-4205
Case Report

“Pure Fat Flap”—Perforator-based Adiposal Layer Only Flap for Lateral Ankle Reconstruction

Seok Joon Lee 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Jeongmok Cho 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Changsik Pak 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Hyunsuk Suh 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Joon Pio Hong 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
› Author Affiliations Funding None.
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Abstract

Lateral ankle soft tissue defects pose challenges, especially in cases due to chronic pressure from cross-legged sitting, which usually present with a large dead space, small skin opening that often accompanies an open joint. Traditional reconstruction methods using fasciocutaneous flaps may result in donor site morbidity such as delayed wound healing or nerve injury. In this article, we present a case of diabetes-related lateral ankle defect successfully treated using adiposal layer only flap, also known as pure fat flap. The anatomy and the surgical technique of adiposal layer only flap were reviewed. These flaps preserve the subdermal plexus and deep fascia while obliterating dead space and providing a gliding surface for proper ankle movement. A perforator-based adiposal layer only flap was elevated from the peroneal artery and used to cover the defect. Flap perfusion was confirmed using indocyanine green video angiography and color duplex ultrasound. Patient had a successful recovery with minimal donor site morbidity. The technique expands the reconstructive microsurgeon's options for complex ankle coverage, ensuring optimal wound healing and functional outcomes.

Keywords

ankle - perforator flap - wound healing

Authors' Contributions

Conceptualization: S.J.L., J.M.C., C.S.P., H.S.S., J.P.H. Data curation: S.J.L. Formal analysis: S.J.L. Methodology: J.P.H. Project administration: J.P.H. Visualization: S.J.L. Writing - original draft: S.J.L. Writing - review & editing: J.M.C., J.P.H. All authors read and approved the final manuscript.


Patient Consent

Written informed consent was obtained from the patient.




Publication History

Received: 04 September 2023

Accepted: 30 January 2024

Accepted Manuscript online:
13 February 2024

Article published online:
10 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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