SLR - June 2022 - Elliott Wityk, DPM
Reference: Li P, Zhang H, Zhu J, Qiu H, Ni X, Yu F, Xiao J, Wang J, Du S. Foot and ankle reconstruction using the lateral supramalleolar flap versus the anterolateral thigh flap in the elderly: A comparative study. Int Wound J. 2022 Mar 23.Level of Evidence: 3
Scientific Literature Review
Reviewed By: Elliott Wityk, DPM
Residency Program: John Peter Smith Hospital, Fort Worth, TX
Podiatric Relevance: This study seeks to compare the outcomes of reconstructive foot and ankle surgery involving soft-tissue defects utilizing lateral supramalleolar and anterolateral thigh flaps, with a focus on determining the optimal surgical strategy for elderly patients. Soft tissue flaps are a wonderful addition to the arsenal of limb salvage techniques at the disposal of the trained podiatric surgeon. A wide array of foot and ankle pathology may lead to soft tissue deficits requiring flap coverage with acute traumatic events and infection and extensive debridement among the most common. The decision of whether a soft tissue flap is a viable option and which flap to consider is both patient and situation/surgeon dependent. Traditionally this work is done by a plastic surgery team, but it is important for the foot and ankle specialist to be aware of the risks and benefits to discuss with their patients, in addition to recognizing when these may be beneficial and referral should be made.
Methods: This was a retrospective study evaluating patients between October 2021 and October 2022 who received either an anterolateral thigh (ALT) flap or lateral supramalleolar (LSM) flap in the treatment of foot or ankle soft-tissue defects. Patients included were those with a unilateral foot or ankle soft tissue defect who underwent flap transfers with a minimum of 1 year follow up postoperatively. 96 patients were included in the review (50 from the ALT flap group and 46 from the LSM flap group). All procedures were performed within a single institution by one team.
Results: Fifty (50) patients were identified in the ALT group, while 46 were identified in the LSM group. The operating time and length of hospitalization time of the LSM group was statistically shorter than the ALT group. The ALT group had statistically higher cost associated compared to the LSM group. Late complications of the LSM group were also statistically significantly lower than the ALT group. No statistical significance in the way of function of the foot and ankle was found between the two groups.
Conclusions: Both ALT and LSM flaps are viable options for foot and/or ankle reconstruction and soft tissue deficit coverage. This retrospective review found shorter operative times, hospitalization time and less cost with LSM flaps, with a lower frequency of postoperative complications than compared to ALT flaps. It is the author’s stance that LSM flaps are the recommended option when dealing with moderate-sized defects of the foot and ankle region in the elderly. In patients that have less concern regarding the cosmetic appearance of the operative limb following soft tissue flap transfer procedure (as is often the case in the elderly), the LSM flap should be the first consideration if soft tissue bulkiness of the donor site and location of the deficit are appropriate.