Background and Objective:

Ankle fractures are one of the most frequently treated by orthopedic surgeons in emergency. The risk of dehiscence and infection of the surgical wound as a result of edema, impaired wound healing and local tissue damage, may cause complex defects affecting both malleoli, requiring an ortho-plastic approach. Because of irregular three-dimensional structure of bimalleolar injuries, it is difficult to cover them with an only microsurgical or pedicled flap, requiring often the use of two islands which vascular axes have independence in terms of mobility.

We present 3 clinical cases collected at the University General Hospital of Alicante (Spain) to describe the coverage of large bimalleolar defects using intrinsic chimeric flaps with double island.

Methods:

Flaps were based on the thoracodorsal artery system, with skin and muscle palette, and on the lateral circumflex femoral artery system, one with skin and muscle palette and another with a double skin palette.

Results:

The survival of the flaps was 100%. The postoperative follow-up was wide, between 2 and 8 years, obtaining a quality coverage without finding dehiscence, local infection or exposure. Patients did not present functional deficits during the follow-up with acceptable aesthetic results.

Conclusions:

This work is one of the few papers existing in the literature that treats in a monographic way the microsurgical treatment of bimalleolar defects, showing an effective strategy in the coverage of a difficult three-dimensional region using a single arterial and venous anastomosis (a single chimeric flap).

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