Anatomical and clinical evaluation of perforator-based flaps of lower limb

Abstract

Background: Wound of lower leg have a poor and delayed healing due to paucity of blood supply. Coverage of defects of leg and foot has always posed a problem for reconstructive surgeon. The objective of this study was to evaluate anatomical basis of various perforator-based flaps in lower limb and their clinical outcome and usefulness.Methods: All patients with post traumatic defects with exposed bones/tendons in the leg and ankle region presenting in MLN Medical college, Allahabad from August 2011 to July 2012 were included in the study.Results: A total 12 patients were included in study. Majority of cases are of compound fracture following accidents involving lower one third of leg. Majority of flaps were based on peroneal artery (5) and posterior tibial artery (5), only 2 flaps were based on anterior tibial artery. Maximum flap length was 21cm and maximum flap rotation was 180º. Complications occurred more in cases having maximum rotation. Result were good in 11 patients and satisfactory in 1 patient with coverage of the defect leading to healing of the wound. More time gap between injury and flap reconstruction leads to more complications and longer hospital stay. Graft site complication occur in 5 cases include partial flap necrosis, infection and venous congestion. There was no complication at the donor site.Conclusions: Perforator based flaps can be used for all large lower leg defects provided there is correct measurement and anatomical knowledge of various perforators, with good functional and cosmetic results.