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Algorithm for Free Perforator Flap Selection in Lower Extremity Reconstruction Based on 563 Cases.

Usama Abdelfattah1, Hollie A Power1, Sinyoung Song1

  • 1From the Department of Plastic and Reconstructive Surgery, Asan Medical Centre; and the Division of Plastic Surgery, University of Alberta.

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Summary

This study shows free perforator flaps are reliable for lower extremity reconstruction. An algorithm aids in selecting the best flap to optimize outcomes and minimize complications.

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Area of Science:

  • Microsurgery
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • Microsurgical lower extremity reconstruction presents significant challenges.
  • The application of perforator flaps is increasingly utilized in these complex reconstructions.
  • Developing a systematic approach for flap selection is crucial for successful outcomes.

Purpose of the Study:

  • To present an algorithm for guiding the selection of ideal free perforator flaps for lower extremity defects.
  • To optimize reconstructive outcomes by tailoring flap choice to specific defect characteristics.

Main Methods:

  • A retrospective review of 563 free perforator flaps used in lower extremity reconstruction over a 7-year period.
  • Documentation of patient demographics, comorbidities, defect details, operative procedures, and outcomes.
  • Pairwise comparisons of different flap types to analyze variations in size, thickness, and pedicle length.

Main Results:

  • Trauma and diabetes were the most common indications for reconstruction.
  • Superficial circumflex iliac perforator and anterolateral thigh flaps were most frequently used.
  • Significant differences in flap size, thickness, and pedicle length were observed among various flap types, with specific measurements provided for each.

Conclusions:

  • Free perforator flaps demonstrate reliability for lower extremity reconstruction.
  • The proposed algorithm aids in optimizing flap selection for improved form and function.
  • The algorithm aims to reduce operative time, donor-site morbidity, and the need for secondary procedures.