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J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499019828546. doi: 10.1177/2309499019828546.

A comparison of fasciocutaneous and adipofascial methods in the reverse sural artery flap for treatment of diabetic infected lateral malleolar bursitis.

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1 Department of Orthopedic Surgery, Gachon University Gil Hospital, School of Medicine, Gachon University, Incheon, Korea.
2 Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea.



Infected lateral malleolar bursitis occurring as a diabetic complication requires debridement and flap surgery because it cannot be treated by conservative methods. The most accessible flap is the reverse sural artery flap, which can be harvested as a fasciocutaneous flap or an adipofascial flap. The purpose of this study was to compare the two types of flap methods performed in patients with diabetic infected lateral malleolar bursitis.


Twenty-nine cases of diabetic infected lateral malleolar bursitis treated with reverse sural artery flap between 2006 and 2017 were analyzed retrospectively. Fasciocutaneous flap methods were performed in 15 cases (group A), and adipofascial flap methods were performed in 14 cases (group B). Patients in the two groups did not differ in sex or age. The mean follow-up period was 16 months.


All flaps survived. Infection was controlled at a mean of 2.4 months in both groups. At final follow-up, infection recurred in one case of each group, which was treated with antibiotics. No case developed an ulcer in the flaps. The patients were able to ambulate in regular shoes. All but one of the patients (28 patients) expressed satisfaction with the aesthetic appearance following treatment. No case required a debulking operation.


Both the fasciocutaneous and adipofascial methods for reverse sural artery flaps were shown to be viable options for the control of diabetic lateral infection. In addition, the two groups did not differ in terms of appearance or complication rate following treatment.


Adipofascial or fasciocutaneous; Lateral malleolus; infected bursitis; reverse sural flap


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