Resurfacing Soft Tissue Defect of Distal Limb Using Perforator Flap from the Lateral Leg Area

Abstract

Background: Perforator flap from lateral leg area is a newly developed flap in recent years. Is it suitable for the reconstruction of distal limb soft tissue defect? Aim and Objectives: Soft tissue defect of the distal limb is a common problem encountered in our daily practice. When tendons, bones, vessels or other major structures are exposed, a vascularized flap is mandatory to resurface the defect and cover the exposed structures. Reconstructive options for soft tissue defect of the extremity include local and free flaps. There are many kinds of flaps described previously in the literatures and each has its advantages and disadvantages. Perforator flap is a type of free flaps that has advantages such as minimal donor site morbidity, short harvesting time etc. It has gained increasing popularity in the modern microsurgical operation. A thin and pliable flap is most suitable for resurfacing defect in the extremity to avoid deformed and bulky appearance after reconstruction. Perforator flap from the lateral leg is a choice in the reconstruction of soft tissue defect of the distal limb. Here we describe our experience in resurfacing soft tissue defect of the distal limb using perforator flap harvested from lateral lower leg. Materials and Methods: We collected data from six patients with soft tissue defect of the distal limb, reconstructed with lateral leg perforator flaps from Jun 2010 to May 2011. Four upper extremities and two lower extremities reconstruction cases were included. Hand-held Doppler probe was used preoperatively to identify the perforators in the proximal or middle lateral lower leg area. Based on the perforators identified preoperatively, we harvested the flap meticulously, dissected the pedicle in a retrograde fashion and source vessels were reached. We also prepared the recipient site for microvascular anastomosis. Donor sites, the lateral leg areas were closed primarily in all six cases. Results: There is one flap loss in a case of lower extremity reconstruction. The other five flaps survived without any complications. Inevitably, linear scar formed over the lateral lower leg area. None was dissatisfied regarding the scar or esthetic appearance of the donor site. All successful cases reported satisfaction with the aesthetic and functional results of the reconstructed hand or foot.Conclusions: Perforator flap from the lateral lower leg area is a reliable flap with thin and pliable skin, making it suitable for resurfacing soft tissue defect in distal limb. Disadvantages of the flap include small calibre perforator, need for meticulous dissection technique and relatively short pedicle length. (J Taiwan Soc of Plast Surg 2012;21:169晋179)