Local perforator flaps for soft tissue defects in lower limb trauma

Abstract

Complex lower limb trauma is a common and major challenge. Limited lower limb local flap options especially in the distal third often necessitate free flap surgery. Fasciocutaneous perforator flaps are an exciting option presenting with less overall morbidity, requiring less specialised expertise than free flaps and can provide excellent cover for small to moderate size defects. To assess the outcomes of fasciocutaneous perforator flaps at our hospital over a 3-year period. Retrospective analysis of all fasciocutaneous perforator flaps performed over that period. There were 20 patients with an average age of 29.8 years (range 10–80). Fifteen were males and five were females. Four were children. Pedestrian vehicle accidents (n = 10), motor vehicle accidents (n = 4), cyclist accident (n = 1), gunshot (n = 1), falls (n = 3) and blunt trauma (n = 1) resulted in Gustillo 3B lower limb fractures (n = 13), full thickness degloving wounds (n = 5) and crush injuries (n = 4). Location of the defects includes the distal third (n = 9), middle third (n = 6), combination middle-distal third (n = 4) and proximal third (n = 1). Average procedure was 129 min (range 70–180) and average time to surgery was 4.3 days (range 0–11). All flaps survived at a mean follow-up of 7 months (range 1–12 months). Complications included epidermolysis (n = 2), partial necrosis requiring limited debridement and split skin graft (n = 3), partial necrosis that healed through secondary intention (n = 1) and tip necrosis (n = 2). No donor site complications were experienced. There were no skin graft losses. Evidence for fasciocutaneous perforator flaps in the lower limb is abundant. This study further substantiates the literature since free style perforator flaps can also be successfully employed in complex traumatic lower limb defects. They appear to be reliable when based on the posterior tibial artery system of perforators for middle and/or distal defects. They are associated with reduced operative time, preservation of the source artery and underlying muscle function, superior aesthetics and fewer complications when compared to free flaps. It has evolved into our first choice for small to moderate size complex defects of the lower limb. Level IV, risk/prognostic study.