Comparision between distally-based peroneal artery perforator-plus and posterior tibial artery perforator-plus fasciocutaneous flap for reconstruction of the distal lower leg,ankle and foot

Abstract

Objective This study is to compare flap-viability-related complications, coverage reach, recon- struction outcomes and donor -mobidities between distally -based peroneal artery perforator -plus fasciocutaneous (DPAPF) flap and distally-based posterior tibial artery perforator-plus fasciocutaneous (DPTAPF) flap for recon- struction of soft-tissue defects over the distal lower leg, ankle and foot, and thus provide evidence for selection of the flaps. Methods Between April, 2002 and February, 2012, 216 and 59 patients underwent the reconstructions with DPAPF flaps (peroneal group) and DPTAPF flaps (posterior tibial group) respectively. We subdivided the distal lower leg, ankle and foot into 12 subregions. In all the patients, flap-viability-related complications and its potential risk factors (including age, sex, etiology, location of top edge, location of pivot point, length and width of both the skin is- land and adipofascial pedicle, length-width ratio, and total length) , coverage reach (the subregion in which the most distal part of the reconstructed defect lies) , duration of flap elevation and hospital stay were compared between the two groups. In patients with at least 3 months postoperative follow-up, comparative study of reconstruction outcomes, pa- tient’s satisfaction with flap appearance and donor -site morbidities were performed between the groups. Results Partial necrosis rate in the peroneal of the posterior tibial group were 12.0 percent versus 20.3 percent, respectively (P > 0.05) . Marginal necrosis and overall complication (including partial and marginal necrosis) rates in the peroneal group (1.9 percent and 13.9 percent, respectively) were significantly lower than those in the posterior tibial group (8.5 percent and 28.8 percent, respectively) (P 0.05) . Incidences of hypertrophic scar, itching and pigmentation at the donor site were significantly lower in the peroneal group (P < 0.05) . Conclusion DPAPF flap is superior to DPTAPF flap in reliability, safe coverage reach and less donor-site morbidities. The former is recommended as the first choice when local pedicle flaps are considered to recon- struct soft-tissue defects over the distal lower leg, ankle and foot. Key words: Perforator-plus fasciocutaneous flap; Peroneal artery; Posterior tibial artery; Complications