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a b c d

e f g
Figure 1: (a) Crush injury to the right heel pad and ankle regions with multiple lacerations on the medial aspect of the foot; (b) crush injury to the
right heel pad and ankle regions with multiple lacerations on the lateral aspect of the foot; (c) picture showing necrotic heel pad tissue; (d) extended
reverse sural artery flap was elevated on day 2 following debridement; (e) extended reverse sural artery flap delay performed; (f) flap inset was
completed on day 4 following debridement; (g) postoperative day 21 following surgery-posterior view

a b c

d e
Figure 2: (a) Ulceration on the lateral malleolus with exposure of the ankle joint; (b) picture following wound debridement and planning of a lateral
supramalleolar flap; (c) lateral supramalleolar flap was elevated on day 2 following debridement; (d) lateral supramalleolar flap delay performed; (e) flap
inset was completed on day 4 following debridement

a b c

d e
Figure 3: (a) Posttraumatic soft tissue defect exposing the lower third of the tibia; (b) distally-based posterior tibial artery perforator plus flap elevated;
(c) distally-based posterior tibial artery perforator plus flap delay performed; (d) flap inset was completed on day 4 following debridement; (e) late
postoperative picture of flap

based on the peroneal or posterior tibial artery perforators venous congestion, which may result in failure at the
are frequently used for reconstruction of defects in this distal aspect of the flap, which may be covering a critical
region. [1-3] These flaps may be harvested as fasciocutaneous, region of the defect. Causes for venous congestion include
islanded fasciocutaneous, adipofascial, or propeller flaps, or compression of the pedicle due to poor elasticity of the
may be harvested as delayed extended flaps. skin over the roof of the tunnel in island flaps, valvular
One common complication encountered during the incompetence, edema at the pedicle region, compartment
utilization of distally-based flaps for such defects is syndrome, and compression of the pedicle by hematoma.

Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015 135