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Abstract
BackgroundLocal flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. These flaps allow efficient coverage of large wounds without the need to sacrifice a major vascular axis. The operative technique does not require microvascular anastomosis and allows reconstruction of soft tissue defects using nearby similar tissues. The aim of this study was to evaluate the clinical results of local perforator flaps in the treatment of complex lower-limb defects.Materials and methodsTwenty-two local perforator flaps were retrospectively studied. Loss of substance was due to postsurgical complications in seven cases, oncological resection in six, posttraumatic defect in five, pressure sores in three, and osteomyelitis in one.ResultsPostoperatively, two patients showed partial flap necrosis. In five patients, a superficial epidermolysis occurred. Minor complications were seen in three patients who showed transient venous congestion of the flap. Furthermore, transient leg edema was sometimes observed in patients with large propeller flaps. All but one patient healed without further major surgical procedures. In three cases, secondary skin grafts were performed. In most cases, the aesthetic result was optimal and patients were fully satisfied.ConclusionsWhen characteristics of the defect are suitable for treatment with a propeller-based local flap, this technique should be considered as one of reasonable options for surgical reconstruction. Microsurgical techniques facilitate the management of complex trauma in emergency and may allow planning reconstructive procedures and limb salvage in elective orthopedic surgery.
Highlights
Background Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs
When characteristics of the defect are suitable for treatment with a propeller-based local flap, this technique should be considered as one of reasonable options for surgical reconstruction
According to the Gent consensus [4], perforator flaps are constituted by areas of cutaneous and subcutaneous tissue nourished by perforator branches originating from deep vascular axis with an intramuscular [musculocutaneous perforator flap (MCPF)] or intraseptal [septocutaneous perforator flap (SCPF)] course
Summary
During the last few years, the strategy for treatment of lower-limb soft tissue defects has changed due to the introduction of new models of local flaps. Improvement in the anatomical knowledge on cutaneous, subcutaneous, and intramuscular vessels originating from major vascular axis of the limbs [1,2,3] has allowed development of several types of perforator flaps, which today are commonly employed in clinical practice. Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. These flaps allow efficient coverage of large wounds without the need to sacrifice a major vascular axis. The aim of this study was to evaluate the clinical results of local perforator flaps in the treatment of complex lower-limb defects. Loss of substance was due to postsurgical complications in seven cases, oncological resection in six, posttraumatic defect in five, pressure sores in three, and osteomyelitis in one
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