Arch Hand Microsurg.  2020 Jun;25(2):151-155. 10.12790/ahm.20.0003.

Reconstruction of Medial Malleolar Defect Using Posterior Tibial Artery Perforator Based Deep Fascial Flap after Malignant Melanoma Ablation

• Heo JW
• Kim YH
• Chung YK

• KMID: 2502713
• DOI: http://doi.org/10.12790/ahm.20.0003

Abstract

The soft tissue structure near the medial malleolus is an area where the bone is covered only with thin skin and subcutaneous tissue without structures like ligaments or tendons. In addition to the above anatomical features, wearing normal footwear should be considered when reconstructing the soft tissues in these areas. Therefore, it may be desirable to restore the original thickness of the soft tissue when performing a reconstruction. The authors reconstructed defects on the medial malleolus of a 50-year-old woman, after wide excision of a malignant melanoma, using only a deep fascial flap based on the posterior tibial artery-based perforator. This technique is thought to be a good option for reconstructing soft tissue defects in this area.

Keyword

Melanoma; Reconstructive surgery; Pedicled flap; Ankle

Figure

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  Fig. 1. A 0.8 cm×0.7 cm sized dark pigmented mole was noted on right ankle. Reconstruction using a posterior tibial artery-based perforator flap was planned. The running of the posterior tibial artery on the skin was marked as photo with Doppler.

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  Fig. 2. After wide excision, a 2-cm proximal point from the medial malleolus was set as the pivot point, and the fascia was cut at the proximal 7 cm from the pivot point and then dissected toward the subfascial plane.

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  Fig. 3. After the flap was turned over to the defect, it was folded once into two layers for reinforcement, fixed on the exposed bone of the medial malleolus.

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  Fig. 4. Schematic illustration of the deep fascial flap. It is shown that the perforator vessels based on posterior tibial artery are segmented and branch out to supply deep fascia (left). The deep fascial flap is turned over based on the pivot point, and the distal perforator is feeding the whole flap (right).

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  Fig. 5. Eleven months after the operation, it was confirmed that the surgical site was maintained stably.

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