Distally Based Medial Leg Flaps Maintained Coverage in Small Ankle Study

All 15 patients undergoing reconstruction with a distally based wide-pedicle medial lower-leg fasciocutaneous flap retained viable tissue coverage at final follow-up, according to a retrospective case series examining treatments for distal foot and ankle soft-tissue defects involving exposed bone or tendon. The operative approach retained the distal posterior tibial artery perforator territory in combination with the saphenous nerve-associated vascular plexus, providing regional wound coverage without the necessity of microvascular anastomosis.

Distal foot and ankle soft-tissue defects accompanied by exposed deep structures such as bone or tendon present persistent reconstructive challenges in clinical practice. The researchers designed their evaluation as a descriptive case series to document clinical observations rather than to introduce a novel reconstructive concept or demonstrate therapeutic superiority over existing surgical strategies.

The study reviewed 15 patients treated between March 2018 and July 2022, comprising 13 men and 2 women with an average age of 36.73 years and an age range spanning 27 to 49 years. Before surgery, clinicians performed Doppler examinations to identify and map the precise anatomical location of the distal posterior tibial artery perforator.

During operative intervention, surgical teams harvested the cutaneous island as part of a distally based pedicled fasciocutaneous unit that preserved an approximately 5-centimeter-wide nonskeletonized tissue pedicle. Postoperative clinical monitoring across the patient cohort ranged from 6 to 18 months, representing a mean follow-up period of 12 months.

Early postoperative complications occurred in two patients (13.3 percent), who developed localized flap swelling alongside dark-purple discoloration on postoperative days 2 and 3. In both instances, tissue perfusion improved following the release of constricting pedicle sutures, limb elevation, and manual massage. At final follow-up, three patients (20.0 percent) exhibited mild residual swelling at the pedicle site, while all donor-site skin grafts achieved complete survival. Functional mobility measurements revealed final ankle dorsiflexion ranging between 10 degrees and 20 degrees and plantar flexion ranging from 20 degrees to 40 degrees.

The study authors highlighted several methodological limitations, noting that cosmetic outcomes were not evaluated using validated patient questionnaires, and variables such as footwear tolerance and requirements for secondary surgical flap thinning were not systematically tracked. Additionally, the retrospective data from this small cohort do not demonstrate superiority or an independent hemodynamic benefit compared with established posterior tibial perforator flaps, reverse sural flaps, or free-tissue transfers, prompting the team to emphasize the need for larger prospective comparative trials incorporating standardized functional and patient-reported measures.

Subject of Research: Clinical outcomes of distally based wide-pedicle medial lower-leg fasciocutaneous flaps for foot and ankle soft-tissue reconstruction

Article Title: Clinical outcomes of a distally based wide-pedicle medial lower-leg fasciocutaneous flap incorporating a posterior tibial artery perforator and the saphenous nerve-associated vascular plexus for foot and ankle soft-tissue defects: a retrospective case series

Article References: Wang, W., Shi, X., Yang, M., Deng, X., Shen, W., Li, W., Zhang, Y., Shi, J., Xue, Y., & Gao, Q. (2026). Clinical outcomes of a distally based wide-pedicle medial lower-leg fasciocutaneous flap incorporating a posterior tibial artery perforator and the saphenous nerve-associated vascular plexus for foot and ankle soft-tissue defects: a retrospective case series. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-026-10579-5

Image Credits: AI Generated

DOI: 10.1186/s12891-026-10579-5

Keywords: fasciocutaneous flap, posterior tibial artery perforator, saphenous nerve vascular plexus, foot soft-tissue defects, ankle soft-tissue defects, soft-tissue reconstruction, retrospective case series, Doppler examination, pedicle flap, ankle dorsiflexion, plantar flexion, donor-site skin graft, pedicle swelling, exposed bone, exposed tendon, microvascular anastomosis, reverse sural flap