Published: 2018-08-25

The lateral supramalleolar flap: a reliable option for lower leg and foot reconstruction

Pradeep Goil, Pankaj Sharma, Manojit Midya, Gautam Prakash


Background: The lateral supramalleolar flap is based on a perforator of the peroneal artery, emanating at approximately 5 cm above the lateral malleolus on the anterior aspect of lower third leg.

Methods: Our technique of harvesting the supramalleolar flap is by using a fasciocutaneous pedicle and minimal perforator dissection. We have done 45 cases in the last 7 years and have got favourable results with this technique.

Results: We have not had a single case of total flap necrosis of a supramalleolar flap in our experience over the last 7 years. We routinely perform this flap when the reverse sural flap territory is not available.

Conclusions: The lateral supramalleolar flap is a useful flap for coverage of lower third leg, ankle and dorsal foot defects. If raised as described, the reliability of this flap is increased.



Supramalleolar flap, Lower third leg, Foot, Ankle, Reconstruction

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Masquelet AC, Beveridge J, Romana C, Gerber C. The lateral supramalleolar flap. Plast Reconstr Surg. 1988;81:74–81.

Romana MC, Masquelet AC. Vascularization of the inner border of the foot: Surgical applications. Surg Radiol Anal. 1988;11:177.

Masquelet AC, Romana MC. The medialis pedis flap: a new fasciocutaneous flap. Plast Reconstr Surg. 1990:85:765.

Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region. Scand J Plast Reconstr Surg. 1983;17:191–6.

Morrison WA, Shen TY. Anterior tibial artery flap: anatomy and case report. Br J Plast Surg. 1987;40:230–5.

Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg. 1992;89:1115–21.

Liu K, Li Z, Lin Y, Cao Y. The reversed-flow posterior tibial artery island flap: anatomic study and 72 clinical cases. Plast Reconstr Surg. 1990;86:312–6.

Wee JTK. Reconstruction of the lower leg and foot with the reversed pedicled anterior tibial flap: preliminary report of a new fasciocutaneous flap. Br J Plast Surg. 1986;39:327–37.

Valenti P, Masquelet AC, Romana C, Nordin JY. Technical refinement of the lateral supramalleolar flap. Br J Plast Surg. 1991;44:459–62.

Voche P, Merle M, Stussi JD. The lateral supramalleolar flap: experience with 41 flaps. Ann Plast Surg. 2005;54:49–54.

Timmons MJ. William Harvey revisited: Reverse flow through the valves of forearm veins. Lancet. 1984;2:394–5.

Nakajima H, Imanisji N, Aiso S, Fujino T. Venous drainage of the radial forearm and anterior tibial reverse flow flaps: anatomical and radiographic perfusion studies. Br J Plast Surg. 1997;50:389–401.

Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap. Plast Reconstr Surg. 1984;74:508–12.

Hyakusoku H, Tonegawa H, Fumiiri M. Heel coverage with a T-shaped distally based sural island fasciocutaneous flap. Plast Reconstr Surg. 1994;93:872– 6.

Rajacic N, Darweesh M, Jayakrishnan RK, Gang RK, Jojic S. The distally based superficial sural flap for reconstruction of the lower leg and foot. Br J Plast Surg. 1996;49:383–9.

Touam C, Rostoucher P, Bhatia A, Oberlin C. Comparative study of two series of distally based fasciocutaneous flaps for coverage of the lower onefourth of the leg, the ankle and the foot. Plast Reconstr Surg. 2001;107:383–92.