Versatility of the Perforator-Based Adipose, Adipofascial, and Fasciocutaneous Flaps in Reconstruction of Distal Leg and Foot Defects

Acartürk, Tahsin Oğuz; Tunc, Suphan; Acar, Firat

doi:10.1053/j.jfas.2014.12.020

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…According to the literature, the dissection plane is usually subfascial but cutaneous, adipose or adipofacial variants have been used favorably. 6 We have always employed subfascial planes for flap harvesting because in lower extremity reconstructions, bulkiness of the flap is not usually an important matter, and, as well, identification and dissection of the pedicle is relatively easy and advantageous in the subfascial plane. Although large defects are documented to be addressed with propeller flaps, generally these flaps are used for reconstruction of small-to medium-sized defects.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of propellar flaps vs. traditional local flaps in lower limb trauma reconstruction

Reddy

Mucherla

2022

Int Surg J

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Background: Adequate coverage of traumatic complex lower extremity wounds is often challenging for reconstructive surgeons. Propeller perforator flaps have gained wide acceptance as an alternative in soft tissue coverage of complex lower extremity defects over the last decade. We report our experience with distal lower extremity reconstructions performed either with traditional local flaps vs. propeller perforator flaps. our aim here was to compare non-microvascular flaps with traditional local flaps for coverage of traumatic lower extremity wounds.Methods: 30 patients operated for lower extremity defects and reconstructed either with traditional local flaps or propeller perforator flaps between November 2016 to December 2020 were included in the study.Results: There were 22 male and 8 female patients. Mean age was 43.00±14.85 (range: 24 to 66 years) in the local flap group and mean age was 42.11±12.05 (range: 23 to 65 years) in the propeller perforator flap group. Hospital stays and overall operation time was significantly higher in the propeller flap group. There was no statistically significant difference in complication rates between either group.Conclusions: Concerning many advantages, like decreased operative time, avoiding micro anastomosis, reconstruction with like tissues, we suggest that propeller perforator flaps can be first-line reconstructive choice. These flaps can be used successfully by reconstructive surgeons in small clinics to prevent unnecessary tertiary medical center referrals as well as extended hospitalizations, long operation times, and increased costs. However, propeller flaps do hold more complications compared to local flaps and do require technical expertise.

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Section: Discussionmentioning

confidence: 99%

Prospective study of propellar flaps vs. traditional local flaps in lower limb trauma reconstruction

Reddy

Mucherla

2022

Int Surg J

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“…Depending on the degree of surgical difficulty and possibility of patient benefit, local pedicled perforator flaps may be the best repair procedure, despite distally based peroneal artery perforator flaps being the most widespread pedicled flaps. 18 , 19 However, the use of pedicled flaps is restricted by their limited reach and reduced amount of soft tissue that can be transported. 20 It is not uncommon for the distal flap to undergo necrosis, exposing the bone or tendon.…”

Section: Discussionmentioning

confidence: 99%

Interperforator Flow Pattern and Clinical Application of Distal Extended Peroneal Artery Perforator Flaps

Deng

Wei

et al. 2018

Annals of Plastic Surgery

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IntroductionPeroneal artery perforator flaps are the most widely used pedicled flaps for soft tissue defects of the distal lower extremity. Most research regarding peroneal artery flaps focuses on the location, diameter, and number of peroneal artery perforators. However, there is little literature regarding interperforator flow patterns within the peroneal artery perforator flaps. The aims of the present study were to describe interperforator flow patterns of the distally based extended peroneal artery perforator flaps through digital subtraction angiography and review their clinical application.MethodsTwelve consecutive patients underwent digital subtraction angiography of the lower-limb arteries. The number and classification of peroneal artery perforators and the interperforator flow patterns were observed. Based on these observations, distally based extended peroneal artery perforator flaps were designed to repair nonhealing wounds located on the ankles and feet of 14 patients.ResultsThe peroneal artery gives out grades I to IV perforators in the lateral leg. There were 2 to 7 grade I perforators and true anastomoses between adjacent grade II perforators, which generate directly linked vessels in the middle leg. The grade III or IV perforators form a reticular vascular network through a large number of chock and potential anastomoses. All flaps survived and had excellent appearance and texture.ConclusionsDistally based extended peroneal artery perforator flaps appear reliable for repairing wounds located on or around the ankle and front foot. However, whether the middle perforator or peroneal artery should be used depends on the condition of the anastomosis between direct linking vessels and the distal perforator.

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“…This is conducive to flap survival and avoids excessive damage to the donor area. [ 3 , 7 , 10 – 12 ]…”

Section: Discussionmentioning

confidence: 99%

Fasciocutaneous flap with perforating branches of peroneal artery repairing soft tissue loss in anterior and middle parts of children's feet

Xiao

Cao²,

Tian³

et al. 2018

Medicine

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Repairing soft tissue loss in feet's anterior and middle parts has become a problem, especially for children. We observed the feasibility and clinical effects of superficial peroneal fasciocutaneous flap pedicled with terminal perforating branches of peroneal artery for repairing children's feet.Between January 2015 and December 2016, soft tissue loss in anterior and middle regions of feet were repaired using superficial peroneal fasciocutaneous flap pedicled with terminal perforating branches of peroneal artery in 8 children with a median age of 6.5 [4–9, interquartile range (IQR) = 3] years. The skin of lower leg was intact, and the soft tissue loss area was located in the anterior and middle regions of feet with a size of 5 cm × 4 cm to 11 cm × 7 cm combined with the exposure of tendons and joints in all the 8 children. On the basis of the conditions above, there were no indications of free skin grafting. Foot wounds were repaired all with the superficial peroneal fasciocutaneous flap pedicled with terminal perforating branches of peroneal artery (6 cm × 5 cm to 12 cm × 8 cm), and then the donor area was sutured to narrow the donor area followed by intermediate split thickness skin graft. The perforating branch trunk of peroneal artery was used as a rotation point (4 cm above the lateral malleolus) in 5 children and descending branch of perforating branch of peroneal artery as a rotation point (2 cm under the lateral malleolus) in 3 children.All flaps survived with primary healing in the 8 children. Postoperative median 7.5-month (3–12, IQR = 4.5) follow-up indicated that flap color and texture were fine, the appearances of donor and recipient areas were satisfactory, wearing shoes was not affected, and walking function and foot blood circulation were normal.For intractable soft tissue loss in the anterior and middle regions of children's feet, superficial peroneal fasciocutaneous flap pedicled with terminal perforating branches of peroneal artery can improve recipient area appearance and walking function because it has the characteristics of reliable blood supply and convenient rotation. It is worth using this method widely in clinics.

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Versatility of the Perforator-Based Adipose, Adipofascial, and Fasciocutaneous Flaps in Reconstruction of Distal Leg and Foot Defects

Cited by 11 publications

References 17 publications

Prospective study of propellar flaps vs. traditional local flaps in lower limb trauma reconstruction

Prospective study of propellar flaps vs. traditional local flaps in lower limb trauma reconstruction

Interperforator Flow Pattern and Clinical Application of Distal Extended Peroneal Artery Perforator Flaps

Fasciocutaneous flap with perforating branches of peroneal artery repairing soft tissue loss in anterior and middle parts of children's feet

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