Revisiting Bipedicled Flaps for Lower Extremity Distal Third Defects.

Area of Science:

• Orthopedics
• Plastic Surgery
• Reconstructive Surgery

Background:

• Distal third lower extremity reconstruction is complex, with free tissue transfer as the standard.
• The COVID-19 pandemic spurred interest in alternative, less resource-intensive reconstructive methods.
• Bipedicled flaps, featuring dual-source subdermal perfusion, emerged as a potential alternative.

Purpose of the Study:

• To evaluate the outcomes of bipedicled flaps in reconstructing distal third leg and foot defects.
• To assess their use as primary or auxiliary local flaps.

Main Methods:

• Retrospective review of 14 patients undergoing lower extremity reconstruction between 2020-2021.
• Inclusion criteria: patients >18 years with traumatic lower extremity wounds treated with bipedicled flaps.
• Exclusion criteria: wounds due to peripheral vascular disease or diabetes.

Main Results:

• 14 patients with distal third leg/foot wounds, 87.5% with concurrent fractures.
• Bipedicled flaps were used alone in some cases and adjunctively with other flaps (hemisoleus, anterior tibialis, etc.) in others.
• 100% limb salvage rate; 14.3% partial flap necrosis, 7.1% nonunion, all healed.

Conclusions:

• Bipedicled flaps are a suitable alternative to free flaps for select distal leg/foot defects.
• They can serve as accessory flaps to aid reconstruction when primary coverage is insufficient.