CLINICAL AND SURGICAL MANAGEMENT OF SOFT TISSUE DEFECTS AROUND THE ANKLE REGION
Main Article Content
Keywords
Ankle Soft Tissue Defects, Reconstructive Surgery, Flap Coverage, Trauma, Reverse Sural Flap, Microvascular Flap, Functional Rehabilitation
Abstract
BACKGROUND
Soft tissue defects around the ankle pose significant challenges due to limited soft tissue coverage, frequent exposure of vital structures, and complex biomechanical demands. Causes include trauma, diabetic ulcers, chronic osteomyelitis, and malignancy. Surgical reconstruction aims to preserve limb function, provide durable coverage, and optimize aesthetic outcomes. The reconstructive approach has evolved from basic wound care to sophisticated flap surgeries, including microsurgical free flaps and perforator-based options.
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 June 2020 to May 2024. A total of 71 patients with soft tissue defects in the ankle region were included. Data collection involved clinical history, imaging, preoperative planning, operative details, postoperative outcomes, and follow-up. Inclusion criteria were defects in the ankle, heel, dorsum of foot, or lower third of the leg unsuitable for primary closure. Surgical techniques varied based on defect size, location, and associated exposure of tendons, bones, or vessels. Patients were followed for at least six months to assess functional and aesthetic outcomes.
RESULTS
The most affected age group was 20–39 years (46.5%), with a male predominance (57.7%). Trauma was the leading cause (76%), followed by diabetic ulcers (11.3%) and osteomyelitis (9.9%). The posterior ankle was the most common wound site (50.7%). Most reconstructions involved reverse sural artery flaps, local flaps, or microvascular free flaps. The highest hospital stay was associated with free flaps (24.8 days). Complications included flap necrosis, infection, and the need for reoperation in some cases. Aesthetic and functional rehabilitation was satisfactory in the majority of patients.
CONCLUSION
Soft tissue reconstruction around the ankle requires individualized, multidisciplinary approaches. Flap selection should be based on defect location, size, and patient comorbidities. Reverse sural artery and microvascular flaps offer reliable coverage with acceptable functional outcomes. Early debridement, meticulous planning, and postoperative care are critical to successful reconstruction and limb salvage.
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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