Superolateral Leg Flap: New Flap with a New Pedicle. Anatomic Study and Clinical Applications

The authors studied 20 cadaver legs and verified the constant presence of a small vessel originating near the tibioperoneal trunk that supplies the soleus or gastrocnemius muscle and the skin of the upper part of the lateral aspect of the leg. This vessel originated from the tibioperoneal trunk in 85% of the legs, in 10% from the anterior tibial artery, and in 5% from the peroneal artery. It had features similar to those in the lateral arm flap (mean diameter = 1.8 mm, mean length = 5.75 cm).

The authors also studied 20 arteriograms to locate this vessel, called the upper peroneal artery. It originated from the tibioperoneal trunk in 89% of cases and from the anterior tibial artery in 11% of cases. The mean diameter was 1.5 mm and the mean length was 5.3 cm. This perforating vessel was also located with a portable Doppler on the upper lateral aspect of the leg in 20 health people. Its site was found to be about 2.8 cm distal and 2.1 cm posterior to the head of the fibula.

After this preliminary anatomic study, a flap with this vessel was used successfully in eight consecutive cases to cover small to medium-sized skin defects at the ankle level. In three of them, the chimeric form (with soleus or gastrocnemius muscle) was used to fill dead bone space. The authors concluded that this new flap has a constant anatomy and is suitable for small or medium-sized lower limb reconstructions, especially as a chimeric flap.