Perforator-based flaps in distal upper and lower extremity defects

Abstract

The reconstruction of complex distal extremity defects is challenging with both cosmetic and functional considerations. This case series reviews our experience of using perforator-based flaps in 28 patients requiring reconstruction of 30 distal extremity defects. Hand held Doppler localisation of the perforators was carried out preoperatively in all cases. Flaps used were either fasciocutaneous or adipofascial and 90% of the defects were post-traumatic. Uncomplicated closure was achieved in 22 cases, with the majority of complications being minor. Complete failure was encountered in only two cases and as such was comparable with our experience of free tissue transfer. We propose consideration of perforator based flaps as an acceptable alternative to free tissue transfer in many extremity defects and find the hand held Doppler probe to be an invaluable tool in flap planning.