Fasciocutaneous Perforator Flap Research Articles

Anatomic feature of the adjacent perforator fasciocutaneous flap of plantar and its clinical application

Objective To study the anatomic basis and its clinical effects of the adjacent perforator fasciocutaneous flap in planta. Methods From October, 2010 to December, 2017, the work was on two fronts:① The blood supply of the flap was studied by the dissection of 5 adult lower limbs which were perfused with red emulsion. Under the magnifying glass, the source of blood supply to the pedicle perforator fasciocutaneous flap near the foot was observed, and the caliber of perforating vessels was measured by vernier caliper. ② Methods based on the anatomic study, the adjacent perforator fasciocutaneous flap was designed to repair plantar defect. Eleven cases with defects in planta were treated with the flap including 5 malignant melanoma, 5 refractory wound and 1 pigmented nevus. The size of defects ranged from 1.5 cm×2.0 cm to 4.0 cm ×5.0 cm with the size of the flaps ranging from 7.0 cm×3.0 cm to 13.0 cm×7.0 cm. Results Anatomical studies showed that the supply vessels of the fasciocutaneous flap near the perforator of the plantar space were plantar medial arteries. The external diameter was greater than or equal to the 0.5 mm perforating number of about 7, the average outer diameter was (0.85±0.19) mm. The medial plantar artery emits multiple branches along the running direction and forms anastomotic branches in the arch of the foot to ensure the blood supply of the flap. Eleven cases of perforator fasciocutaneous flaps survived, including 1 case of distal necrosis of small area and healed after change dressings. The follow-up results during 6-24 months showed that all patients were walking normally, with full texture and no localized dull pain. Conclusion On the basis of the extent of diseases, projected the adjacent perforator fasciocutaneous flap, the wear resistance and abrasive resistance are improved resulted from flaps with similar skin texture of defects. The donor site can be closed directly without skin graft. It is an simple and reliable method to repair medium and small- sized plantar defects. Key words: Plantar; Perforator flap, fasciocutaneous flap; Applied anatomy; Repair

Gastrocnemius Myocutaneous Flaps for Knee Joint Coverage.

The gastrocnemius muscular flap has already proven its efficiency for soft tissue coverage in cases of knee joint exposure. However, it may be too small to cover large defects and has not the same aesthetic and mechanical properties as normal skin. Perforator fasciocutaneous flaps have recently been described in knee joint coverage with good results as they replace skin by skin, but they can be hard to harvest. Gastrocnemius flaps can be easily harvested with a planned skin paddle designed over the chosen muscle. This simple technique combines the advantages of muscular and fasciocutaneous flaps for knee joint area coverage. Perforator fasciocutaneous flap take a growing place in coverage of this localization in recent literature, but very few articles report the results of gastrocnemius myocutaneous flaps (MCFs). All patients who underwent knee joint coverage with the use of a lateral or medial gastrocnemius MCFs between January 2012 and February 2017 in our university institution were included in this retrospective study. Sixteen gastrocnemius MCFs (10 medial and 6 lateral) were performed. The indication was posttraumatic in 5 cases, posttumoral in 5 cases, and after total knee prosthesis exposure in 6 cases. Skin paddles up to 15 cm in width and 18 cm in length were harvested. Complete healing was achieved in 15 days in all cases without suffering or nonunion. Three flaps were secondarily raised to allow total knee prosthesis reimplantation or arthrodesis, and 4 patients were treated with postoperative radiotherapy without complication. In addition to its reliability and very easy harvesting, the gastrocnemius MCF allows a robust joint coverage and good skin resurfacing that makes eventual revision easier and allows early radiotherapy. Furthermore, skin paddle also increases the effective area of the flap. This technique should always be considered with the other classic alternatives.

Defektdeckung durch Gluteuslappen

Gluteal skin, fasciocutaneous and myocutaneous flaps can be used to cover decubitus ulcers in the sacral and ischiocrural area. Decubitus ulcers in the sacral or ischial area that do not heal after exhausted conservative therapy. Moribund patients who are very likely to suffer a life-threatening complication. Non-cooperative patients who cannot follow the postoperative recommendations. The presence of extensive scars after previous operations in the donor area or irradiation of the donor area which may compromise the flap perfusion. A distinction is made between local skin flaps, perforator-based fasciocutaneous flaps and the myocutaneous gluteus maximus flap. By partial or complete elevation of the gluteus maximus muscle based on the superior and inferior gluteal vessels, this flap is useful for larger and deep defects in the sacral and ischial region. For more superficial defects, fasciocutaneous perforator flaps might be used. Smaller ulcers can be treated with local skin flaps. The donor site should be closed primarily. Consistent, postoperative relief by prone and lateral positioning of the patient, avoiding new decubitus ulcers. Drainage for at least 5-7 days. Antibiotic therapy is indicated only with appropriate detection of pathogens and in case of persistent infection. With distinct anatomical and improved technical knowledge, the use of fasciocutaneous and myocutaneous flaps in the gluteal region is now an established procedure and can be used for reliable coverage of sacral and ischiocrural decubitus ulcers.

Functional results of free tissue transfer for complex heel-calcaneal defects.

Loss of soft tissue in heel-calcaneal region is frequently caused by trauma, infection, or tumors. Limited availability of similar tissue becomes challenging, therefore, the use of free tissue transfer offers a solution. Our aim is to describe long term functional outcome of different free tissue transfers for these defects. We retrospectively reviewed 24 consecutive cases of the heel-calcaneal defect between January 2009 and December 2014. The free fasciocutaneous perforator (FCP) flaps were performed in 14 cases and free muscle flaps with skin graft in 10 cases. The postoperative complications, range of motion and ability of ambulation or exercise were administered to evaluate functional results. The average follow-up period was 26.5 months. The survival of free flap was 100%. Early complication included venous thrombosis, infection and edge dehiscence was noted in 8 cases. Late complication with insensate ulcers developed in 3 cases (1 cases in FCP flap, 2 cases in muscle flap). All ulcers healed spontaneously without surgical intervention. The postoperative average range of motion of ankle regained 52.79 degree in FCP flap group and 56.4 degree in muscle flap group. The ability of ambulation or exercise returned in 13 cases in FCP group (13/14) and 9 cases in muscle flap group (9/10). No differences of complication rate (P = .403), ROM (P = .363) or functional evaluation (P = .803) could be found between these two groups. Both FCP flap and muscle flaps provided the similar and excellent functional results in resurfacing of heel-calcaneal defects after long term follow up.

Abstract: 17.00 Freestyle Pedicled Perforator And Propellar Flaps: Anatomic Studies And Clinical Application

INTRODUCTION: Freestyle perforator flaps have been described for soft tissue reconstructions throughout the body. The flaps are designed in accordance to the defect, the surrounding available perforators, and excess regional tissue. Knowledge of the anatomic angiosomes and respective perforators provide a broad spectrum of available pedicled flaps for the reconstructive surgeon. We present our anatomic studies and the clinical application of freestyle perforator flaps in the trunk, head and neck, and limb. MATERIALS AND METHODS: Cadaveric anatomic studies were performed to identify reliable perforators based on individual angiosomes. In clinical cases, perforator-preserving incisions were used without the use of a hand-held Doppler or pre-operative imaging. Freestyle fasciocutaneous perforator flaps were harvested following subfascial identification of the largest perforator(s). Flaps were designed based on the defect size, location of the recipient site, and nearby available tissue. Dissection of the perforator was continued to its main vascular trunk for optimal mobility and rotation of the flap. Flaps were rotated or tunneled for final inset, and those that extended into a tertiary angiosome were supercharged as necessary. RESULTS: From January 2012 to June 2015, 42 patients were reconstructed with freestyle perforator flaps without the aid of handheld Doppler or pre-operative imaging. Donor sites were primarily closed in 83.3% of the cases. Total complication rate was 21.4%, with 7 patients (16.7%) presenting with distal flap necrosis. All healed with re-advancement of the flap or dressings. There were no complete flap losses. All defects were adequately closed with the designed flaps. CONCLUSIONS: Understanding of the anatomic perforasomes throughout the body provides the astute reconstructive surgeon with ample reconstructive options for the use of pedicled flaps. Freestyle perforator flaps are a safe and reliable option for trunk, head and neck, and limb soft tissue reconstruction and do not require the use of handheld Doppler or preoperative imaging.

Detailed vascular anatomy of the medial femoral condyle and the significance of its use as a free flap

The aim of this study is to provide detailed information on the arterial variations of the descending geniculate artery (DGA) for the harvest of a cortico-periostal flap from the medial femoral condyle and a fascio-cutaneous perforator flap with its respective pedicles. A total of 50 lower limbs from embalmed cadavers were dissected. The distribution pattern, length, and diameter of the DGA, saphenous artery (SA), muscular, periostal, and articular branches, and their concomitant veins were measured and evaluated. The DGA was present in 98% of the cases. In 80%, a Y-shaped distribution was identified where the SA branched from the DGA. Here, the mean lengths of DGA, SA, and the articular branch of the DGA were 3.2±1.1, 7.18±3.2, and 6.72±2.07cm, respectively. In 18%, an H-shaped distribution was noted, where the SA emerged directly from the femoral artery with a length of 10.2±1.9cm, whereas the length of the DGA (and its terminal articular branch) was 7.5±1.5cm. The mean length of the arterial pedicle for a cortico-periostal flap from the medial condyle was 9.92cm, whereas for the fascio-cutaneous perforator flap, it was 9.46cm in Y-shaped distribution and 10.2cm for the H-shaped distribution. Different arterial distribution patterns increase the need for routine preoperative vascular imaging when planning to harvest a cortico-periostal flap and a fascio-cutaneous perforator flap from the medial femoral condyle, especially when a double-chimeric flap is targeted. Level 4, case series.

The anatomy basis and clinical application of the horn fasciocutaneous perforator flaps for the reconstruction of the defects on finger soft tissue

To discuss the clinical effect of horn perforator flaps for the treatment of finger soft tissue defect. ① Lead oxide-gelatin mixture injection and CT scanning were performed in 4 fresh adult cadavers and the data was put into mimics 17.0 to achieve the three-dimensional reconstruction. The regulation and origins of the perforator vessel in proper palmar digital artery was observed. ② From July 2012 to July 2015,9 cases with finger soft tissue defects were treated with horn perforator flaps. The defect areas ranged from 0.6 cm × 0.8 cm to 1.2 cm × 1.5 cm and the flap size ranged from0.8 cm×2.5 cm to 1.6 cm×4.2 cm. We put the head end of flaps at defect side. The horn perforator flap was designed with 1-2 perforator vessel and rotated to cover the defect. The defect at donor site was closed directly. We got 4 symmetric arteries in palmar and back surfaces of fingers,2 for proper palmar digital arteries and 2 for dorsal digital arteries. The proper palmar digital arteries have a larger diameter which is the main source of blood supply for fingers. All 9 flaps survived after the operation. Both the recipient area and donor areas received sound healing. With 2 months to 1.5 years of follow-up visit, the shape, color and luster, texture and function all had good healing. The horn perforator flaps for repair finger soft tissue defect have advantages of flexible design, reliable perforator vessels. The defect at donor site can be closed directly with no skin graft. This method considers both shape and function and is a good way for finger soft tissue defect.

A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy

Distal half leg complex wounds are usually a formidable problem that necessitates either local or free flap coverage. The aim of this study was to compare cost billing charges in free Gracilis flap (fGF) and local fasciocutaneous perforator flap (lFPF) in reconstructing complex soft tissue leg and foot defects. Thirty consecutive adult (>15-year-old) patients with soft tissue defects in the leg and/or foot requiring tissue coverage with a flap in the period between 2012 and 2015 were randomly assigned (block randomization) to either an fGF or lFPF procedure. The outcome measures addressed were total billed charges costs, perioperative billed charges cost, partial or complete flap loss, length of hospital stay, inpatient postsurgical care duration, complications, operating time and number of operative scrub staff. One patient suffered from complete flap loss in each group. Reconstruction with lFPF showed total lower billed charges costs by 62% (2509 USD) (p<0.001) and perioperative billed charges cost by 54% (779 USD) (p<0.001), and shorter total hospital stay (36.5 days; p<0.001), inpatient postsurgical care duration (6.4 days; p<0.001), operating time (4.3h; p<0.001) and fewer scrub staff (2.2 persons; p<0.001). These results suggest that neither flap is totally superior to the other; the choice should instead be based on the outcome sought and logistics. lFPF requires lower billed charges cost and resource use and saves operative time and personnel and reduces length of hospital stay. Our approach changed towards using perforator flaps in medium-sized defects, keeping the free flap option for larger defects.

Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Simultaneous Reconstruction of Forefoot and Hindfoot Defects with a Thoracodorsal-Axis Chimeric Flap.

Medial Sural Artery Perforator Flap: Using the Superficial Venous System to Minimize Flap Congestion.

Use of the pedicled medial sural artery perforator (MSAP) fasciocutaneous flap has been widely reported in the literature for ipsilateral lower limb reconstruction. Depending on defect location, the MSAP flap may be utilized as a propeller or V-Y advancement flap [1]. This perforator flap is typically based on the proximal perforator of the medial sural artery supplying the gastrocnemius muscle. One of the main issues encountered when performing an MSAP flap is venous congestion [2], a commonly described complication in other perforator based flaps [3]. We describe a useful technique to overcome this problem by including the superficial vein into the original flap design. A 57-year-old woman was referred to our department with a malignant melanoma in the left popliteal fossa. Histologically the lesion was reported as having a 0.8 mm Breslow thickness. The resulting defect was 5 cm×5.5 cm (Fig. 1). Handheld Doppler was used to locate and mark the perforators preoperatively across the medial head of gastrocnemius. Although more accurate methods can be used to map the perforator, handheld Doppler offers time efficiency and reduces input from radiological investigations [4]. Flap harvest commenced with an incision placed above the medial border of the medial head of the gastrocnemius. A branch of the long saphenous vein superficial to the fascia was encountered and preserved and seen to enter the medial side flap (Fig. 2). Two perforators were identified. The vein was mobilized free from the lateral skin flap to provide enough mobility for flap advancement. The flap was raised subfascially from distal to proximal with identification and preservation of two MSAP (Fig. 3). The two perforators were skeletonised with minimal intra-muscular dissection. This ensured the flap could be advanced proximally 5 cm in a V-Y fashion and inset (Fig. 4). No venous congestion was encountered following flap inset (Fig. 5). This case report suggests that venous augmentation with the superficial branch of the long saphenous vein in MSAP flap improves venous drainage, as has previously been described by Hallock [2]. It can most effectively be utilized in V-Y advancement MSAP flaps, where the movement is unidimensional, as no rotation of the flap is required which may lead to vascular compromise and consequent flap compromise. In the distally based flap, the technique of phlebotomy to relieve flap congestion via an exteriorised segment of short saphenous vein has been described, contributing to favourable flap survival [5]. Short saphenous branch preservation is a useful and relatively simple method of reducing the risk of MSAP flap congestion without prolonging dissection time. Fig. 1 Wide local excision of malignant melanoma left popliteal fossa with resulting 5 cm ×5.5 cm defect. V-Y advancement flap designed based on a dominant perforator marked with an X. Fig. 2 The medially located superficial branch of the short saphenous vein. Fig. 3 Two median sural artery perforators were identified and dissected on the lateral aspect of the flap. Fig. 4 V-Y flap raised subfascially and advanced into defect. Fig. 5 Medial sural artery perforator flap 4 months postoperatively.

Avoiding Skin Grafts: The Keystone Flap in Cutaneous Defects.

Therapeutic, IV.

Second intercostal internal mammary artery perforator (IMAP) fasciocutaneous flap as an alternative choice for the treatment of deep sternal wound infections (DSWI)

Sternal wound infections after sternotomy are associated with high morbidity, high mortality and escalating treatment costs. Repeated radical debridement - with the removal of any hardware - and wound conditioning are the prerequisites for reconstruction. Muscle and, less frequently, omentum flaps are usually used for reconstruction. However, these flaps are associated with considerable donor-site morbidity, long operation times and aesthetic impairment. Fasciocutaneous flaps seem to be an alternative. This study presents our experience of using the second intercostal mammary artery fasciocutaneous perforator flap for defect closure in nine patients (mean age: 70.2 years). Following a retrospective chart review, we assessed data on patient demographics, the type of cardiac surgery, the prevalence of deep sternal wound infection (DSWI) risk factors, identified pathogens, surgery duration, hospitalization tim patients had undergone coronary artery bypass surgery, and two had valve replacements. The mean duration of surgery (121.4 ± 39 min) was short. The patients had a mean body mass index (BMI) of 32.8 ± 4.9 kg/m(2). An average flap size of 124 ± 22 cm(2) sufficiently covered and obliterated each defect. One mediastinal haematoma required revision surgery. One wound dehiscence at the flap and two at the donor site were managed conservatively. Our experience reveals that a fasciocutaneous flap based on the second intercostal perforator of the internal mammary artery can be an alternative, quick-to-prepare flap for covering sternal defects. In adipose patients, it has sufficient bulk, and it is large enough to cover common sternal wounds. It also has low complication and morbidity rates, and it achieves an aesthetically pleasing result.

Island Latissimus Dorsi Muscle Flap and a Perforator Flap in Repairing Post-Gunshot Thoracic Spine CSF Fistula: Case Presentation

Persistent posttraumatic CSF fluid leakage may present a challenge to manage. Failure to address the leakage may result in complications such as meningitis, septicemia, radiculopathy, muscle weakness, and back pains. While the majority of the leakages may be managed conservatively, large dura defects as a result of gunshot wounds or motor vehicle accidents are best managed by surgical interventions. This may range from primary closure of the defect to fascial grafts, adhesive glues, and flaps. We present our experience with the use of flaps in a patient who had sustained such wounds in the thoracic spine. An island latissimus dorsal flap and a perforator fasciocutaneous flap were used to close the defect. Postoperatively the patient recovered well and the wounds healed without any complications.

Free Tissue Harvest from the Thigh

BACKGROUND: The thigh offers a myriad of reconstructive options, from fasciocutaneous perforator flaps, to free functional muscle and composite tissue constructs. The surgeon should be familiar with the advantages and disadvantages specific to each flap in order to tailor the reconstructive plan to the needs of each patient. The authors reviewed the relevant donor-site morbidities associated with more commonly utilized thigh-based flaps. METHODS: A systematic review of the MEDLINE and Cochrane databases from 1994 to 2014 was conducted to identify all reports of “anterolateral thigh,” “anteromedial thigh,” “transverse upper gracillis,” tensor fascia lata,” “gracillis,” “rectus femoris,” and “vastus lateralis” flaps. Only studies that investigated donor-site outcomes related to pain, parasthesia, wound dehiscence, infection, hematoma, seroma, contour deformity, and/or objective functional performance were included. Case series or anecdotal reports with fewer than 5 flaps, as well as non-English and animal studies were excluded. RESULTS: From the initial 2,425 citations, 121 articles met criteria and were manually reviewed by two authors (Figure 1). A total of 4,276 flaps were analyzed, including 2,727 ALT, 102 AMT, 436 TUG, 193 TFL, 527 Gracilis, 164 RF, and 127 VL flaps. Of these, 3,458 (80.8%) were perforator-based flaps. The most frequently sited donor-site complication was parasthesia (n=496), followed by wound dehiscence (n=144), musculoskeletal dysfunction (n=69), infection (n=66), and pain (n=47). The frequency of donor-site skin grafting was highest among AMT flaps (22.5%), as were pain (4.9%) and parasthesia (19.6%). Donor-site dehiscence occurred over 3 times as often with the TUG flap when compared to other flap types (8.03% vs 2.2%). Despite mixed results regarding functional performance, there were no clinically significant reductions in strength, daily activities, or quality of life specific to any donor-site. Compared to perforator-flaps, muscle-flap reconstructions were associated with increased pain (2.1% vs 0.9%), infection, (2.2% vs 1.4%), and contour deformity (3.1% vs 0.6%). Rates of musculoskeletal dysfunction however, were similar in both (0.9% vs 1.8%) (Table 1).Figure 1: Trial-Flow Diagram.Table 1: Donor-Site Morbidity for Given Flap Type.CONCLUSION: Donor-site morbidity for commonly used thigh-flaps is minimal and appears to be well tolerated by most of patients. However, flap selection is highly individualized, and patients must be informed of potential complications and morbidities specific to each flap. We have established the most current review of donor-site morbidity for thigh-based flaps to aid the surgeon in this important discussion.

Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps.

BackgroundReconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores.MethodsWe retrospectively analyzed data from 14 patients (16 ischial sores) whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course.ResultsAll flaps survived the entire follow-up period. Seven patients (50%) had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years). The mean follow-up period was 27.9 months (range, 3-57 months). In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%), wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%), but resolved with conservative treatment. Among 16 cases, there was only one (6%) recurrence at 34 months.ConclusionsThe combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores.

Clinical application of the adjacent horn shaped perforator fasciocutaneous flap in the trunk area

To study the anatomy basis for the clinical application of the adjacent horn shaped perforator fasciocutaneous flap for the reconstruction of small and medium-sized defects in the trunk area. (1) Ten adult antiseptic cadavers (20 sides) were perfused with red latex. The skin blood supply, line of the blood vessels, branches in accordance with the distribution and crossing were observed. (2) Fifteen cases with defects in the trunk were treated with the adjacent horn shaped perforator fasciocutaneous flaps. The defects size ranged from 5 cm x 5 cm to 13 cm x 13 cm with the size of the flaps ranging from 10 cm x 6 cm to 35 cm x 15 cm. The trunk skin is supplied by mainly 17 groups arteries such as thyrocervical trunk, internal thoracic artery, posterior intercostal arteries, superior epigastric artery, arteria epigastrica inferior, lumbar arteries, and so on. The perforators (diameter > 0.5 mm) numbers are about 20, 40, 24, 6, on the chest, abdomen and perineum, upper back, waist, respectively. All the flaps survived completely with primary healing both on donor and recipient sites. The flaps color, texture, function and appearance were satisfactory during the follow-up period of 1-24 months. The adjacent horn shaped perforator fasciocutaneous flap should be designed flexibly. The defects in the donor sites could be closed directly without skin graft. It is an effective, easy and ideal method for the reconstruction of large defects in the trunk.

The “Chimeric” Trapezius Muscle and Fasciocutaneous Flap (Dorsal Scapular Artery Perforator Flap)

Multiple variations of the musculocutaneous trapezius flap have been described, each of which use a single composite musculocutaneous unit in their designs. The limitation of such designs is the ability to use the components in a 3-dimensional manner, with only 1 vector existing in the geometry of the musculocutaneous unit. A review of the literature was undertaken with regard to designs of the musculocutaneous trapezius flap, and we present a new technique for flap design. With identification of individual perforators to each of the muscle and fasciocutaneous portions of the trapezius flap, the 2 components can act in a chimeric fashion, able to fill both a deep and complex 3-dimensional space while covering the wound with robust skin. A range of flap designs have been described, including transverse, oblique, and vertical skin paddles accompanying the trapezius muscle. We describe a technique with which a propeller-style skin paddle based on a cutaneous perforator can be raised in any orientation with respect to the underlying muscle. In a presented case, separation of the muscular and fasciocutaneous components of the trapezius flap was able to obliterate dead space around exposed cervicothoracic spinal metalwork and obtain robust wound closure in a patient with previous radiotherapy. This concomitant use of a muscle and fasciocutaneous perforator flap based on a single perforator, a so-called chimeric perforator flap, is a useful modification to trapezius musculocutaneous flap design.

Complex Heel Reconstruction with a Sural Fasciomyocutaneous Perforator Flap

Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified "sural fasciomyocutaneous perforator flap" and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap.

Versatility of the Greater Saphenous Fasciocutaneous Perforator Flap in Coverage of the Lower Leg

Paucity of soft tissue locally available for reconstruction of defects in the leg and foot remains a challenge. Greater saphenous fasciocutaneous perforator flap in reconstruction of the lower leg has been used effectively to cover these defects. In many situations, it is a viable alternative to free flaps and cross-leg flap reconstruction. The objective of this retrospective study was to evaluate the efficacy of the greater saphenous fasciocutaneous perforator flap for reconstruction of the medial and anterior lower leg, medial malleolus, and hind foot. A total of 26 patients with soft tissue defects of the medial and anterior lower leg, medial malleolus, and hind foot were evaluated. Preoperative data, age, sex, defect etiology, defect size, flap dimension, postoperative results, and complications were recorded. All patients were followed up postoperatively. The procedure was uneventful in 25 of 26 patients. The one unsuccessful flap developed partial necrosis of the distal edge due to venous congestion, and secondary healing was achieved by conservative treatment. No patient showed signs of infection. The defect etiology in all patients was trauma of the lower extremity or its complications, most frequently open fracture (19 patients), followed by osteomyelitis of the tibia (2 patients). The greater saphenous fasciocutaneous perforator flap is versatile, reliable, and useful in coverage of medial and anterior lower leg, malleolus, and hind foot defects. This surgical technique is a safe, short-duration alternative to microsurgical reconstruction.

Application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar

To investigate the application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar. The proximal end of the plantar fasciocutaneous perforator flaps were at the edge of defects. The deep fascia was cut off at the both sides of flaps. The plantar fascia should be included into the flaps. Then the flaps were rotated to cover the defects, containing two or three perforators. If necessary, the original supplying vessels could be cut off to facilitate the advancement of flaps. From Jan. 2010 to Oct. 2012, 7 cases with plantar defects were treated with the horn shaped perforator flaps. The defects size ranged from 1.5 cm x 2.0 cm to 4.0 cm x5. 0 cm with the size of the flaps ranging from 7 cm x 3 cm to 13 cm x 7 cm. All the flaps survived completely with primary healing both on donor and recipient sites. The flap color, texture, function and appearance were satisfactory during the follow-up period of 3-24 months. The plantar horn shaped perforator flap can reconstruct the defects at plantar weight-bearing area with the similar thick skin tissue, which facilitates the functional reconstruction. No skin graft is necessary for the defect at donor site.