A five year review of islanded distally based fasciocutaneous flaps on the lower limb

The use of the distally based islanded fasciocutaneous flap is described in 61 patients with lower limb defects and its application in coverage of compound fractures of the tibia is highlighted. A total of 66 flaps were raised from the posteromedial border of the leg, based on a single perforator off the posterior tibial artery. Flap coverage extended to include defects of the lower one third of the leg (n = 47) as well as the ankle, heel and foot (n = 4). Bony stabilisation was performed with a tibial intramedullary locking nail in 30 out of 53 fractures; mean time to bony union was 5.9 months. Mean operating time was 1.7 hours and mean hospital stay was 25 days (range 8-98 days). Mean follow-up time was 13 months (maximum 5 years). Twenty-five flaps were used to cover Gustilo IIIb fractures primarily, with a 20% complication rate in this group. The flaps were used preferentially in males and in older females. The overall flap failure rate was 7.6%, with a further 10.6% of flaps suffering from tip necrosis and haematoma formation. Contributory factors to suboptimal healing included the presence of peripheral vascular disease and heavy smoking.