Skin perforator flaps: an algorithm for leg reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Vascular Surgery

Background:

• Local fasciocutaneous flaps for lower limb defects offer low donor site morbidity but face reliability issues.
• Perforator flaps are versatile and indicated for various clinical problems, especially in extremity reconstruction.

Purpose of the Study:

• To evaluate the reliability and outcomes of skin perforator flaps in lower limb defect reconstruction.
• To compare the efficacy of different types of perforator flaps, including peroneal artery, posterior tibial artery, and medial sural artery flaps.

Main Methods:

• A retrospective study of 34 skin perforator flaps raised in 33 patients between September 2007 and November 2010.
• Specific flap types included peroneal artery flaps (13), posterior tibial artery perforator flaps (0.16), and medial sural medial gastrocnemius muscle perforator skin flaps (5).
• Segmental perforators were dissected and retained; flap survival and complications were documented.

Main Results:

• A high flap survival rate of 32 out of 34 flaps was achieved, with no instances of venous compromise.
• One flap was completely lost, and another experienced partial tip necrosis; both were managed conservatively.
• Skin perforator flaps demonstrated improved vascularity compared to conventional lower limb flaps.

Conclusions:

• Skin perforator flaps represent a significant technical advancement for lower limb reconstruction, offering enhanced reliability and vascularity.
• These flaps provide surgeons with valuable additional reconstructive options for challenging leg injuries and defects.
• Careful clinical judgment is crucial for assessing the vascular territory and ensuring successful flap outcomes.