title: Improving the reliability of the distally based posterior tibial artery adipofascial flap with the great saphenous venoneural network.
abstract: The distally based posterior tibial adipofascial flap is a useful option for distal leg and ankle coverage. Traditionally, its dimension is constrained by a length-to-width ratio of 2:1. We have increased this ratio to 4:1 by including the great saphenous vein and saphenous nerve with the flap. These structures with their venoneural network, and their connections with posterior tibial artery perforators, form the vascular axis of the flap. In our series of 21 flaps, 70% (n = 15) had ratios of 3:1 or higher. In remaining 30% (n = 6), the ratio was 2:1, as the defects were more proximal. Complications include one complete flap loss due to compression from tunneling and one superficial tip necrosis. Postoperatively, we performed wet-to-wet dressings, phlebotomy, and delayed skin grafting to optimize flap survival. Of 21 flaps, 20 were healthy after an average follow-up of 24 months.
authors.affiliation: Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Tun Lin
authors.initials: TL
authors.lastname: Foo
authors.forename: Winston Yoon-Chong
authors.initials: WY
authors.lastname: Chew
authors.forename: Bien-Keem
authors.initials: BK
authors.lastname: Tan
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000601:surgery; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012501:Saphenous Vein / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D013977:Tibia / Q000098:blood supply; D016909:Tibial Arteries / Q000601:surgery*