title: Distally based lateral and medial leg adipofascial flaps: need for caution with old, diabetic patients.
abstract: BACKGROUND
  Reconstruction of defects around the ankle region has always been challenging for plastic surgeons. Distally based lateral and medial leg adipofascial flaps are among the flaps of choice for coverage of this difficult region. Presented here is the authors' clinical experience with these flaps, particularly emphasizing the complicated attempts in diabetic patients.
  
  
  METHODS
  Seven skin defects around the ankle were reconstructed with lateral and medial leg adipofascial flaps. The lowermost perforators of the peroneal or posterior tibial artery were identified preoperatively, and a straight incision through skin only was made proximal to this perforator. With the skin flaps reflected, the adipofascial flap was than raised in the subfascial plane. The perforators to be retained in the base were located and the flap was then turned over to cover the defect, followed by application of a split-thickness skin graft over the flap. The donor site was closed primarily.
  
  
  RESULTS
  The ages of the patients ranged from 25 to 80 years, and the size of the flaps ranged from 3 x 5 cm to 7 x 10 cm. Four defects were reconstructed with lateral leg adipofascial flaps, and medial leg adipofascial flaps were used in three. Two flaps healed uneventfully. Partial or total graft loss and partial flap necrosis were observed in five patients, four of whom were diabetic.
  
  
  CONCLUSIONS
  Leg adipofascial flaps offer a valuable option for repair of defects around the ankle in many cases. However, adipofascial flaps should be used with caution in old, diabetic patients and, when performed, the probability of a second or third procedure should be considered.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University, Faculty of Medicine, Ankara, Turkey. yenerdemirtas@hotmail.com
authors.forename: Yener
authors.initials: Y
authors.lastname: Demirtas
authors.forename: Suhan
authors.initials: S
authors.lastname: Ayhan
authors.forename: Yakup
authors.initials: Y
authors.lastname: Sariguney
authors.forename: Fulya
authors.initials: F
authors.lastname: Findikcioglu
authors.forename: Onur
authors.initials: O
authors.lastname: Cukurluoglu
authors.forename: Osman
authors.initials: O
authors.lastname: Latifoglu
authors.forename: Seyhan
authors.initials: S
authors.lastname: Cenetoglu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000601:surgery; D002111:Calcaneus / Q000293:injuries*; D003646:Debridement; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012086:Reoperation; D013524:Surgical Flaps / Q000473:pathology