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Arch Hand Microsurg > Volume 25(2); 2016 > Article
Archives of Hand and Microsurgery 2016;25(2):37-42.
Published online November 30, 2016.
Close-by Islanded Posterior Tibial Artery Perforator Flap: For Coverage of the Ankle Defect
Sujin Bahk, SeungHwan Hwang, Chan Kwon, Euicheol C. Jeong<sup>1</sup>, and Su Rak Eo<sup><xref ref-type="corresp" rid="cor1">*</xref></sup>
1Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Medical Center, Goyang, Korea.
2Department of Plastic Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea.
Received: 24 April 2016   • Revised: 31 July 2016   • Accepted: 17 August 2016


Soft tissue coverage of the distal leg and ankle region represents a surgical challenge. Beside various local and free flaps, the perforator flap has recently been replaced as a reconstructive choice because of its functional and aesthetic superiority. Although posterior tibial artery perforator flap (PTAPF) has been reported less often than peroneal artery perforator flap, it also provides a reliable surgical option in small to moderate sized defects especially around the medial malleolar region.

Materials and Methods:

Seven consecutive patients with soft tissue defect in the ankle and foot region were enrolled. After Doppler tracing along the posterior tibial artery, the PTAPF was elevated from the adjacent tissue. The average size of the flap was 28.08±9.31 cm2 (range, 14.25 to 37.84 cm2). The elevated flap was acutely rotated or advanced.


Six flaps survived completely but one flap showed partial necrosis because of overprediction of the perforasome. No donor site complications were observed during the follow-up period and all seven patients were satisfied with the final results.


For a small to medium-sized defect in the lower leg, we conducted the close-by islanded PTAPF using a single proper adjacent perforator. Considering the weak point of the conventional propeller flap, this technique yields much better aesthetic results as a simple and reliable technique especially for defects of the medial malleolar region.

Key Words: Surgical flaps, Perforator flap, Posterior tibial artery, Ankle

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