Preservation of the Superficial Peroneal Nerve Does Not Compromise Lateral Supramalleolar Flap Viability

Abstract

Background: The lateral supramalleolar flap is a useful local flap for defects around the lateral malleolus. However, this flap is classically harvested subfascially, which requires superficial peroneal nerve (SPN) transection with loss of dorsal foot sensation and potential for chronic pain. We explore whether suprafascial harvest with nerve preservation results in a viable flap. Methods: Clinical cases include five patients who presented with a soft tissue defect at the lateral malleolar area. The etiologies included traumatic, decubitus, and chronic wounds. The suprafascial lateral supramalleolar flap was performed to reconstruct the defect while preserving the SPN. Results: Four flaps and one flap were performed as one-stage operation and delayed fashion, respectively. All flaps survived without complications. The SPN was identified and preserved in all cases. Postoperatively, the sensory distribution of the SPN was maintained in all patients. Conclusion: The lateral supramalleolar flap can be safely raised in the suprafascial plane, sparing the SPN.