Lower extremity soft tissue defects frequently result from high-energy trauma or oncological resection. The lack of suitable muscle flap options for the distal leg and foot makes defects in these locations especially challenging to reconstruct and free tissue transfer is commonly used. Another option that has become more popular in the past two decades are pedicled perforator flaps. Based on a thorough literature review and the authors’ experience on leg perforator flaps for over a decade, this article presents a historical review, the anatomical basis of common perforator flaps of the leg and foot, patient selection, wound selection, perforator selection, flap design, surgical techniques, refinements, and postoperative care. A review of the clinical outcomes and complications of these flaps was also performed and was noted to be comparable to the outcomes of free tissue transfer with significantly lower total flap failure rate. It is hoped that this review will assist surgeons in the formulation of a comprehensive step-by-step guide in performing pedicled perforator flap reconstruction of the lower extremity.

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Background. Intraoperative frozen section (IFS) is often utilised in the surgical treatment of nonmelanocytic skin cancer (NMSC) in sensitive facial regions when Mohs micrographic surgery (MMS) is not available. Objective. To compare the outcome of NMSC patients with excision performed with and without IFS. Materials and Methods. A retrospective, single-centre study was performed on all patients who had undergone resection of NMSC with and without IFS control at the National University Hospital (NUH) from 2010 to 2015. Results. 116 patients were recruited, of which 86 had IFS and 30 did not. The complete excision rate of patients with IFS was higher at 87.2% ( p = 0.0194 ), need for secondary operation was lower at 1.2% ( p = 0.005 ), and need for postsurgery radiotherapy or chemotherapy was lower at 1.2% ( p = 0.001 ). The average duration of surgery in patients who underwent IFS was 95.4 minutes compared to 70.1 minutes in cases which did not undergo IFS. Conclusion. Our study showed an increased complete excision rate and reduced need for secondary surgeries and adjuvant therapy in patients with IFS. However, a longer operative duration was required. Use of IFS may be useful in patients with NMSC lesions in sensitive regions requiring complex reconstruction after tumour excision.