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CC BY 4.0 · Indian J Plast Surg
DOI: 10.1055/s-0045-1809152
Original Article

Anatomical Study of the Anastomosis Stations of Lateral Supramalleolar Artery Flap and Its Application in the Reconstruction of Distal Leg, Ankle, and Dorsum of Foot Defects

Thalavirithan Margabandu Balakrishnan 
1   Department of Plastic Surgery, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India
,
U. Raseedha Begum
2   Department of Plastic Surgery, Madras Medical college and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
,
Madhuvanti Sarada Bharathwaj
2   Department of Plastic Surgery, Madras Medical college and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
,
Madhumitha S.
2   Department of Plastic Surgery, Madras Medical college and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
,
Pavithra Thangavel
2   Department of Plastic Surgery, Madras Medical college and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
,
M. Sugumar
2   Department of Plastic Surgery, Madras Medical college and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
› Author Affiliations
Funding None.
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Abstract

Introduction

A study was conducted to reveal the anatomy of the perforators and stations of anastomosis of the lateral supramalleolar artery (LSMA) axis and to analyze the outcome of various avatars of the flap based on the LSMA axis.

Materials and Methods

Ten cadaveric dissections were performed to study the anatomy of the LSMA axis. Twenty patients with distal third leg, ankle, and dorsum of foot defects underwent reconstruction using the various avatars of the LSMA axis flaps. At the end of the follow-up, they were all assessed using the Institutional Functional and Aesthetic Outcome Assessment scoring system by two independent observers.

Results

The cadaveric study showed consistent anatomical details of superficial peroneal nerve artery-LSMA-descending branch of ramus perforans anastomotic axis and their perforators. In the clinical study, the average size of the primary defect was 63.6 cm2. The average follow-up period was 12.5 months. Three (15%) noncritical complications were reported in our study, which were all managed conservatively. Fifty-five percent (n = 11) of patients had a good/excellent final computed institutional assessment score (p = 0.025). The rest of the patients (45% [n = 9]) had a fair outcome score.

Conclusion

Reconstructing soft tissue defects in the distal third of leg, ankle, and foot presents a considerable challenge. The LSMA flap and its various avatars may be a useful addendum in the reconstructive armamentarium for coverage of distal third leg, ankle, and dorsum foot defects.

Keywords

lateral supramalleolar artery flap - anastomotic stations - distal leg defects - ankle and dorsum of foot defects


Publication History

Article published online:
20 May 2025

© 2025. 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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