Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

Abstract

Background:Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb.Patients and Methods:After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up.Results:There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient.Conclusions:Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

Strategic Use of Biodegradable Temporizing Matrix (BTM) in Wound Healing: A Case Series in Asian Patients

“…We preferred to use this flap for lower leg reconstruction especially the distal third defect with implant exposure. Because adipofascial flap can preserve the major leg vessels, with minimal donor-site morbidity and relatively easy and rapid dissection, it has been widely used and reported in previous studies [24,25]. However, the adipofascial tissue might not be a perfect wound bed for STSG take, and graft loss would be sometimes encountered [26].…”

Delayed Stepwise Rotation for the Salvage of a Congested Perforator-Pedicled Propeller Flap in Distal Lower Extremity with Severe Edema

“…The other alternative is the adipofascial flap for the coverage of lower leg defects. However, this requires a skin graft on the flap, which makes the flap monitoring difficult 11) . In the present case, the PPP flap was employed against all these alternatives to ensure the reliability of blood supply, streamline microsurgical burden, and ensure the feasibility of postoperative monitoring.…”

Letter to the Editor: Comment on Li, et al. Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region (Ann Plast Surg. 2020;84:580–587)

“…Neither is sural nerve part of the abovementioned flap nor is the medial sural artery. These flaps are possibly described as distally based posterior tibial artery perforator turn over adipofascial flaps 2,3 …”