Fasciocutaneous flaps in the lower limb soft tissue reconstruction – A surgical case series

Abstract

Traumatic injuries, metabolic, vascular and malignant diseases are among the main causes of soft tissue defects in the lower limb. The limited tissue resources and the peculiarities of the blood supply make reconstructive treatment a challenge. Various modalities of fasciocutaneous flaps have been gaining popularity in the treatment of soft tissue defects in the lower extremity. A retrospective analysis including a group of 19 patients with soft tissue defects in the lower limb, treated in the period June 2019–July 2021 in the Department of Burns and Plastic Surgery, UMHATEM “N. I. Pirogov” was conducted. Twenty fasciocutaneous flaps were performed (6 - Keystone flaps, 6 - Reverse flow Sural flaps, 4 - Perforator Propeller flaps, 2- V–Y perforator flap, 2 - Axial Rotation flap). Demographic and clinical data is analyzed. Functional (LEFS) and aesthetic evaluation (POSAS 2.0) of the achieved results is obtained. Patients were of both sexes, aged between 23 and 78 years. All of the flaps survived. Minor complications occurred in 3 cases. Significant functional improvement and satisfactory aesthetic results were reported. Free tissue transfer, considered as the “gold standard” in the reconstruction of complex defects involving the lower limb, has its drawbacks. Fasciocutaneous flaps are a good alternative option to free flaps. They are characterized by good functional results and rare complications. Utilization of the fasciocutaneous flap strategy is a reliable method for ensuring the integrity and the function of the lower limb. • Fasciocutaneous flaps can be used reliably in lower limb soft tissue reconstruction. • Respect to the perforasomes is crucial. • Greatest mobility has the sural flap. • Perforator propeller flaps are capable of transferring largest amount of tissue. • Significant functional improvement and satisfactory aesthetic results are reported.