ANATOMICAL CONSIDERATIONS IN RECONSTRUCTIVE OPTIONS FOR THE ANKLE AND FOOT
Main Article Content
Keywords
Foot and Ankle Reconstruction, Anatomical Flap Planning, Reverse Sural Flap, Medial Plantar Flap, Soft Tissue Defects, Reconstructive Elevator, Microsurgery, Limb Salvage.
Abstract
BACKGROUND
Soft tissue reconstruction of the foot and ankle is complex due to limited soft tissue availability, unique anatomical constraints, and high mechanical demands. These regions are prone to injuries and chronic wounds owing to trauma, infection, ischemia, and systemic conditions like diabetes. A deep anatomical understanding-encompassing embryology, vascular supply, fascial compartments, and muscular structure-is essential to guide appropriate reconstructive strategies, reduce complications, and improve functional outcomes.
METHODS
This retrospective study was conducted at the Department of Plastic Surgery, RGSSH (Rajiv Gandhi Super Speciality Hospital), RIMS (Raichur Institute of Medical Sciences), Raichur, from January 2021 to December 2024. A total of 71 patients with soft tissue defects in the ankle region were included. The selection criteria focused on defects unsuitable for primary closure and requiring flap coverage. A detailed assessment of each case was done with clinical history, imaging, and intraoperative findings. Operative decisions were made based on anatomical location, exposure of critical structures (bone, tendon, vessels), and patient-specific considerations. Various local, regional, and free flap options were utilized. Postoperative outcomes were evaluated in terms of aesthetic appearance, complication rate, and functional rehabilitation over follow-up.
RESULTS
Trauma was the predominant cause of ankle and foot defects. The posterior ankle and lower third of the leg were the most common locations. The most frequently used flaps included the reverse sural artery flap, medial plantar flap, and extensor digitorum brevis muscle flap, while free tissue transfers were reserved for large or complex defects. Complications included partial flap necrosis, donor site issues, and flap bulkiness. Functional outcomes were satisfactory in the majority, with most patients regaining stable ambulation. Anatomical knowledge played a critical role in selecting and executing appropriate reconstruction techniques, ensuring flap viability and minimizing morbidity.
CONCLUSION
Successful reconstruction of ankle and foot defects necessitates a thorough understanding of regional anatomy and a multidisciplinary approach. Anatomical insights significantly enhance surgical planning, facilitate optimal flap selection, and improve both functional and aesthetic outcomes. Adapting to the reconstructive elevator model rather than the traditional ladder enables surgeons to achieve superior limb salvage in complex cases.
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Dr. Raghavendra S.
Assistant Professor, Department of Plastic Surgery, Rajiv Gandhi Super Speciality Hospital, Raichur Institute of Medical Sciences, Raichur, Karnataka, India
Dr. Asha J.
Assistant Professor, Department of General Surgery, Raichur Institute of Medical Sciences, Raichur, Karnataka, India