Versatility of perforator flaps for lower extremity defect coverage: Technical highlights and single center experience with 87 consecutive cases

Abstract

Background Lower extremity defects have been and remain one of the greatest challenges in reconstructive surgery. Perforator flaps have been accepted as a valid procedure to cover such a defect. Different techniques have been described and nowadays many options are available. However, there were not studies that comprehensively review the most modern techniques and clinical application of the use of perforator flaps in the lower extremity reconstruction. In the present report, we gathered most of them, presenting an updated and large case series where different pedicled and free perforators flaps were employed in simple and complex scenarios in a large series of cases. Patients and Methods Eighty‐seven patients presenting soft tissue defects of the lower extremities were treated by means of different perforator‐based flaps, in either free or pedicled fashion. The flaps were based on different perforator vessels, namely deep lateral circumflex femoral artery, profunda femoris artery, superficial femoral artery, medial sural artery, peroneal artery, posterior tibial artery, anterior tibial artery, and medial plantar artery. Patients' mean age was 61.9 years old (range 21—87 years old), 58 were males and 29 females. The 12 patients received sequential flaps and 9 received double free flaps, for a total sum of 106 flaps. The causes of the defects were trauma in 41 patients and tumors in 46 patients, located throughout the lower limbs. Size of the defect ranged from 3 cm × 4 cm to 25 cm × 9 cm. Results The dimensions of the flap skin paddles ranged from 3 cm × 4 cm to 16 cm × 5 cm for the pedicled flaps (42 cases) and from 6 cm × 4 cm to 25 cm × 8 cm for the free ones (45 cases). Mean flap's size was 48 cm2 (range 12–80 cm2) for the pedicle flaps and 104 cm2 (range 24—200 cm2) for free flaps. In two pedicled cases, a distal congestion was encountered, requiring a second surgery. Debulking procedures were performed in 2 patients. All the patients were successfully treated and no flaps were lost. Mean follow‐up period was 8.4 months (range 3–12 months). No range of motion impairment was encountered after surgery and all the patients were able to return to habitual life. Conclusions The present case series highlights the reliability and versatility of perforator flaps for lower extremity defect coverage. Following careful consideration of the etiology, dimensions, location, patient comorbidities, and presence of adequate perforators, a pedicled or free perforator flap can be potentially successful in the most disparate circumstances.

Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects

“…A chimeric perforator flap consisting of independent tissue flaps, such as skin flaps and muscle flaps with their own independent vascular supply linked to a common vascular source, has many advantages in covering extensive tissue defects [6,[27][28][29][30][31][32].…”

Free peroneal artery perforator flap for reconstruction of traumatic limb soft tissue defects: A retrospective case series study

“…The reconstructive surgeons have made lots of progress to restore good appearance and satisfying function for these suffering patients. Many techniques, such as biomedical material covering, growth factor injection, and physical therapy have long been used in experimental and clinical applications but show limited clinical performance (Henn et al, 2018; Ogawa, 2019; Scaglioni et al, 2022). Elliot et al recommended repair of soft tissue defects in finger, thumb and forearm with less invasive methods that might lead to similar consequences (Elliot et al, 2018).…”