Trochanteric area reconstruction with free flap using perforators as recipients: An alternative and effective option

Reconstructing soft tissue defect on the trochanteric area is challenging. Due to the significant complications associated with regional flap, free tissue transfer is an appropriate option. However, this area has poor recipient vessels. Therefore, we present perforators as suitable recipient vessels to facilitate the use of free flap coverage for the successful reconstruction of defects in the trochanteric area.

From 2013 to 2017, 10 patients underwent free flap reconstruction for soft tissue defects of the trochanteric area. After preoperative computed tomography or magnetic resonance imaging images confirmed the enhanced perforating artery, the skin site was identified by Doppler. If the vessel was confirmed as reliable, the operation was performed in the same manner as for other free flaps.

All of the flaps survived, and the perforators selected for surgery included four superficial circumflex iliac artery perforators, four tensor fasciae latae artery perforators, and two inferior gluteal artery perforators. The average diameter of the recipient artery was 0.97 mm and that of the vein was 0.94 mm. One case exhibited arterial insufficiency caused by compression of hematoma; however, complete flap survival was achieved in this case with revised surgery.

Reconstructing soft tissue defects in the trochanteric area is limited in recipient vessels. However, using a perforator vessel as a recipient facilitates the reconstruction by free flap coverage. This method leads to acceptable flap survival and sufficient padding, with reduced morbidity and collateral injury.