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Perforator-sparing transposition flaps for lower limb defects: anatomic study and clinical application.

Chin-Ho Wong¹, Bien-Keem Tan

¹Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore. wchinho@hotmail.com

Annals of Plastic Surgery

|May 25, 2007

Summary

Preserving perforators in local fasciocutaneous flaps enhances vascularity for lower limb defect coverage. This technique is reliable for knee and mid-leg defects but challenging in the distal leg.

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Area of Science:

Plastic Surgery
Reconstructive Surgery
Microsurgery

Background:

Local fasciocutaneous flaps offer low donor-site morbidity for lower limb defect coverage.
Flap reliability, particularly vascularity, remains a significant challenge in lower limb reconstruction.

Observation:

This study investigated preserving perforators to the tip of conventional local fasciocutaneous flaps to enhance vascularity.
Twenty-one perforator-sparing transposition flaps were raised in cadaveric leg specimens across three regions: knee/proximal-third, middle-third, and lower-third/ankle.
Success was defined as tension-free transposition to cover defects.

Findings:

Flaps in the knee/upper-third and middle-third regions were successfully closed in all cases.
In the lower-third and ankle regions, 3 of 7 flaps failed due to inadequate perforator length and tendon interference.

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The technique was successfully applied in 6 clinical cases.

Implications:

Perforator-sparing local fasciocutaneous flaps offer improved vascularity compared to conventional flaps.
This technique is feasible and safe for lower limb defects in the knee and upper and middle thirds of the leg.
It presents a valuable alternative to local muscle flaps for reconstructive needs in these specific areas.