A Three-step Algorithm for Axial Pattern Flap Selection in Repairing Deep Soft Tissue Defects of the Lower Extremity

This study aims to summarize an algorithm for flap selection in the repair of deep lower extremity defects with bone, tendon, or joint cavity exposure.

The medical records of patients with deep lower extremity defects repaired using axial pattern flaps between January 2007 and December 2023 in our department were retrospectively reviewed. A three-step algorithm for axial pattern flap selection was formulated. Outcomes were evaluated based on flap survival rate, functional recovery of the affected limb, complications, and patient satisfaction.

Ninety-six patients with a mean age of 51.2 y (range: 11-77 y) were included. The three-step algorithm involved sequential evaluation of the defect location, vascular condition of potential flaps and the size of the defect. Patients were followed up for 6 mo to 2 y. The flap survival rate was 100%, with no severe complications observed. The mean Lower Extremity Functional Scale score was 65.6 (range: 46-75). Overall, 85.4% of patients were satisfied with the outcomes.

The three-step algorithm for axial pattern flap selection-based on defect location and size, and vascular condition of potential flaps-can achieve satisfactory long-term outcomes and serves as a practical and straightforward method in clinical practice.