A review of local and regional flaps for distal leg reconstruction

Reconstruction of defects or wounds of the distal third of the leg with exposed bone, tendon, or hardware is challenging. Free tissue transfer has allowed limb salvage in many cases but requires a relatively healthy and stable patient, long operative times, and a significant expense. Small and moderate-size wounds of the distal leg may be better served by the use of local and regional flaps. Due to a better understanding of leg vascular anatomy and angiosomes, as well as more sophisticated and varied flap designs, local and regional flaps have been described and successfully used in distal leg wounds. The goal is choosing the most appropriate flap given the patient's anatomy and wound characteristics. The following review will detail the available local and regional flaps for reconstruction of the distal third of the leg with an emphasis on decision making, anatomy, flap design, and technique.