Anatomical Study of the Anastomosis Stations of Lateral Supramalleolar Artery Flap and Its Application in the Reconstruction of Distal Leg, Ankle, and Dorsum of Foot Defects

Sep 28, 2026

An anatomical study examined the perforators and anastomotic stations of the lateral supramalleolar artery (LSMA) axis and evaluated reconstructive outcomes using various LSMA-flap avatars. Ten cadaveric dissections characterized the LSMA-associated anastomotic axis, its perforators, and related arterial and neural components. Twenty patients with distal third leg, ankle, and dorsum of foot defects underwent reconstruction, with functional and aesthetic outcomes scored by two independent observers. Results included consistent anatomical findings, an average defect size of 63.6 cm2, a 12.5-month mean follow-up, mostly good/excellent outcomes, and conservative management of reported noncritical complications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Materials and Methods

Results

Conclusion

Article published online: 2025-05-20 436 Original Article THIEME Anatomical Study of the Anastomosis Stations of Lateral Supramalleolar Artery Flap and Its Application in the Reconstruction of Distal Leg, Ankle, and Dorsum of Foot Defects Thalavirithan Margabandu Balakrishnan 1 U. Raseedha Begum2 Madhuvanti Sarada Bharathwaj2 Madhumitha S.2 Pavithra Thangavel2 M. Sugumar2 1 Department of Plastic Surgery, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India 2 Department of Plastic Surgery, Madras Medical college and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India Indian J Plast Surg 2025;58:436–446. Address for correspondence Thalavirithan Margabandu Balakrishnan, MB, MS, FRCS, DNB, MS, DNB, MCh, 103, JRD Beverly Hills, Kovaipudur, Coimbatore 641042, Tamil Nadu, India (e-mail: [thalaviri.b@gmail.com](thalaviri.b@gmail.com)). Abstract Keywords ► lateral supramalleolar artery flap ► anastomotic stations ► distal leg defects ► ankle and dorsum of foot defects Introduction A study was conducted to reveal the anatomy of the perforators and stations of anastomosis of the lateral supramalleolar artery (LSMA) axis and to analyze the outcome of various avatars of the ﬂap based on the LSMA axis. Materials and Methods Ten cadaveric dissections were performed to study the anatomy of the LSMA axis. Twenty patients with distal third leg, ankle, and dorsum of foot defects underwent reconstruction using the various avatars of the LSMA axis ﬂaps. At the end of the follow-up, they were all assessed using the Institutional Functional and Aesthetic Outcome Assessment scoring system by two independent observers. Results The cadaveric study showed consistent anatomical details of superﬁcial peroneal nerve artery-LSMA-descending branch of ramus perforans anastomotic axis and their perforators. In the clinical study, the average size of the primary defect was 63.6cm2. The average follow-up period was 12.5 months. Three (15%) noncritical complications were reported in our study, which were all managed conservatively. Fifty-ﬁve percent (n ¼ 11) of patients had a good/excellent ﬁnal computed institutional assessment score (p ¼ 0.025) . The rest of the patients (45%[n ¼ 9]) had a fair outcome score. Conclusion Reconstructing soft tissue defects in the distal third of leg, ankle, and foot presents a considerable challenge. The LSMA ﬂap and its various avatars may be a useful addendum in the reconstructive armamentarium for coverage of distal third leg, ankle, and dorsum foot defects. Introduction In the past decade, there has been a signiﬁcant rise in the adoption of microvascular free tissue transfer to address soft tissue defects in the distal third leg region. Despite the array of available techniques today, considering the steep learning article published online May 20, 2025 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1809152 . ISSN 0970-0358. curve associated with microsurgery and the risk of free tissue transfer failure, employing local ﬂaps remains crucial in the arsenal of plastic surgery. Among these options, the lateral supramalleolar artery (LSMA) ﬂap stands out as a dependable choice for effectively addressing defects in the ankle, foot, and distal leg regions. The LSMA is the name given for © 2025 . The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited.([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) Thieme Medical and Scientiﬁc Publishers Pvt. Ltd. , A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Avatars of LSMA Flaps and Its Anatomical Basis Balakrishnan et al. 437 Fig. 1 Schematic diagram showing station one, two, and three anastomoses for the lateral supramalleolar artery (LSMA) ﬂap. the a

FAQs

What was the aim of the study on the lateral supramalleolar artery (LSMA) flap?

To reveal the anatomy of the perforators and anastomosis stations along the LSMA axis and to analyze reconstructive outcomes using different LSMA-flap avatars.

How was the anatomical assessment performed?

Ten cadaveric dissections were conducted to study the anatomy of the LSMA axis, including the anastomotic stations and associated perforators.

What were the main clinical outcome findings and complications?

In the clinical study, the average defect size was 63.6 cm2 and mean follow-up was 12.5 months. Good/excellent scores were seen in 55% of patients, fair in 45%, and three noncritical complications (15%) were managed conservatively.

Sep 28, 2026

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