Title: Temporalis fascia free flap reconstruction of acute ankle defects

SDCC 

Methods: We report a retrospective study of 25 patients treated in our unit for acute ankle wounds between 2008 and 2022 and who underwent superficialis temporalis fascia (FST) free flap reconstruction. There were 19 males and 6 females. The mean age was 38 years old (5 to 62 years old). The location of defects was: Medial malleolar (12 cases), Achilles tendon (8 cases) and dorsum of the foot ( 1 cases). The mean surface area of the wounds was 36 cm2. 16 cases were post-traumatic with 4 cases involving crush injury. The remaining 9 cases involved wound complications from orthopedic reconstruction with exposed or infected hardware.


Results: Operative times ranged from 3.5 hours to 5 hours. All flaps were performed with end to side anastomoses in both arterial and venous positions (posterior tibial in 21 cases and dorsalis pedis for the other cases). Immediate STSG's were performed after the revascularization of the FST. Occlusive dressings were used for 5 days and flap monitoring was done by Doppler exam. Ankle mobility was limited by splint or cast. There were no microvascular complications and no flap failures. One skin graft failure requiring repeat STSG and one donor site alopecia (2 cm width) occurred. Minimum follow up is one year. All wounds healed primarily with no subsequent breakdown. All patients considered the scar at the donor site as invisible or minimal.

Conclusion: For us the FST flap has many advantages. It is thin, pliable and results in a very hidden scar at the donor site. This flap is our first choice in the management of small wounds around the ankle. The only limit is the surface area of the FST which can be appropriate only for small defects.

Reconstructive

PSTM 2024