Peroneal island flap for wound coverage in complex injuries of the lower extremity (original) (raw)
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Anatomical and clinical evaluation of perforator-based flaps of lower limb
International Surgery Journal
Background: Wound of lower leg have a poor and delayed healing due to paucity of blood supply. Coverage of defects of leg and foot has always posed a problem for reconstructive surgeon. The objective of this study was to evaluate anatomical basis of various perforator-based flaps in lower limb and their clinical outcome and usefulness.Methods: All patients with post traumatic defects with exposed bones/tendons in the leg and ankle region presenting in MLN Medical college, Allahabad from August 2011 to July 2012 were included in the study.Results: A total 12 patients were included in study. Majority of cases are of compound fracture following accidents involving lower one third of leg. Majority of flaps were based on peroneal artery (5) and posterior tibial artery (5), only 2 flaps were based on anterior tibial artery. Maximum flap length was 21cm and maximum flap rotation was 180º. Complications occurred more in cases having maximum rotation. Result were good in 11 patients and sati...
Vojnosanitetski pregled, 2014
Background/Aim. Fasciocutaneous flaps are tissue flaps that include the skin, subcutaneous tissue and underlying fascia, and are based on the septocutaneous system of blood vessels. They have a number of characteristics that give them an advantage in many cases, especially in treatment of lower extremity defects. The aim of this study was to clinically analyse the outcomes of patients surgically treated with a. peroneae perforator-based reverse flaps of the lower leg. Methods. This prospective study was conducted on a group of 22 patients with tissue defects in the lower third of the lower leg and foot. All the 22 patients underwent standard diagnostic procedures and the preoperative preparation for spinal anesthesia. During the surgery, the location of the recipient site with a future flap and an accompanying vascular stem was marked. Having prepared the recipient site in accordance with the surgical principles, the lobe was prepared, rotated and positioned in the defect region. Re...
The Extended Peroneal Artery Perforator Flap for Lower Extremity Reconstruction
Annals of Plastic Surgery, 2010
The peroneal artery perforator flap and its modifications have been widely used for coverage of soft tissue defects of ankle and foot in the past decade. In this article, we report on a series of upper knee, ankle, and foot reconstructions with a proximally or distally based extended peroneal artery perforator (EPAP) flap supplied by distinct perforating branches off the proximal or distal peroneal artery. Total pedicle length obtained ranged from 6 to 12 cm. Twelve patients with soft tissue defects of the lower extremity underwent reconstruction using the EPAP flap. The flaps were designed with the sizes from 10 ϫ 6 cm to 25 ϫ 15 cm. All 12 flaps survived completely without complications. Our experience demonstrates that the EPAP flap is reliable and versatile and can provide a large amount of soft tissue for coverage of defects in the leg anywhere from knee to forefoot obviating the need for free tissue transplantation.
Peroneal Flap: Clinical Application and Cadaveric Study
Archives of plastic surgery, 2017
The goal of this study was to investigate the anatomy of the peroneal artery and its perforators, and to report the clinical results of reconstruction with peroneal artery perforator flaps. The authors dissected 4 cadaver legs and investigated the distribution, course, origin, number, type, and length of the perforators. Peroneal artery perforator flap surgery was performed on 29 patients. We identified 19 perforators in 4 legs. The mean number of perforators was 4.8 per leg, and the mean length was 4.8 cm. Five perforators were found proximally, 9 medially, and 5 distally. We found 12 true septocutaneous perforators and 7 musculocutaneous perforators. Four emerged from the posterior tibia artery, and 15 were from the peroneal artery. The peroneal artery perforator flap was used in 29 patients. Retrograde island peroneal flaps were used in 8 cases, anterograde island peroneal flaps in 5 cases, and free peroneal flaps in 16 cases. The mean age was 59.9 years, and the defect size rang...
Microsurgery, 2008
The distally based neurocutaneous flaps have been popular for lower leg and foot reconstruction. On the basis of pre-existing anatomic studies and clinical experiences, we designed a reversed superficial peroneal neurocutaneous island flap with the descending branch of the distal peroneal perforator as the pedicle. The flap is supplied through both axial perforator and longitudinal chain-linked vascular plexuses. This modified neurocutaneous island flap, measuring around 5 cm 3 4 cm to 12 cm 3 13 cm in size, was transferred for coverage of foot soft-tissue defects in 21 cases with a low complication rate. Compared to the original neurocutaneous flap, the rotation point of this flap is more distal and the pedicle is thinner. It could provide good texture and contour matching to the recipient area. In conclusion, the modified neurocutaneous island flap provides a reliable tool for repairing soft-tissue defects of the ankle and foot. V V
The Egyptian Journal of Hospital Medicine
Background: Open wound of the lower limb is one of the common health problems that have a significant economic and social burden. It has a risk of osteomyelitis of the underlying bone and even necrosis can occur. Objective: To evaluate the difference between the perforator-based island flaps and fasciocutaneous flaps in reconstruction of lower extremities regarding; functional, aesthetic outcome, size of the flap, degree of rotation, technical difficulties, percentage of flaps survival, flap loss, operative time and donor site morbidity. Patients and Methods: The study was conducted on 40 patients with soft tissue defects in lower extremities which were equally distributed into two groups. Group 1 consisted of 20 patients that were treated by perforator based island flap and group 2 that consisted of 20 patients treated by fasciocutaneous flap. Results: The two techniques had similar results when evaluated by the Likert scale. The results of both procedures had no significant statistical differences as regards any of the Likert score components namely, color, texture, appearance, and shape. The main finding of the current study was the comparable postoperative outcome for both techniques. The number of patients that had necrosis was 7 in perforate based island flap and 4 in fasciocutaneous flap which represented 35% and 20% respectively of each studied group and this was statistically insignificant. Conclusion: Any flap can be used as a perforator-based island flap in which the source vessel is completely preserved. Perforator flaps have multiple advantages over Fasciocutaneous flaps as allowing increased diversity and versatility in the design and composition of flaps.
Role of Perforator Flaps in Leg and Foot Reconstruction
The Egyptian Journal of Hospital Medicine
Background: Lower extremity wounds have been always a challenge for reconstructive surgeons. Free perforator flaps are considered to be the best option for this problem but require the complexity of microsurgery. So, pedicled perforator flaps have emerged as an alternative option. The aim of the present study is the assessment of efficacy of perforator flaps (either free flaps or pedicled flaps) regarding the coverage of traumatic soft tissue defects on the leg and foot. Patients and methods: A prospective study was conducted upon 40 patients with traumatic soft tissue defects in the leg and foot. The free flaps used were anterolateral thigh flap (ALT) and medial sural artery perforator flap (MSAP). In pedicled perforator flaps group, 10 cases were designed as propeller flaps, while the other 10 flaps were designed as perforator plus flaps. Results: Free flaps were mainly used for large sized defects; one case of partial flap loss and one case of complete flap necrosis. MSAP flap was the first option for coverage of large sized defects on foot and ankle as it's a thin and pliable flap, while ALT flap was used for coverage of larger defects on the leg. Pedicled perforator flaps were used mainly for small to medium-sized defects especially in the lower third of the leg; we had 3 cases of flap loss in propeller flap design while we had no cases of flap loss in perforator plus flap. Conclusion: Perforator flaps have become a reasonable solution for soft tissue defects of the lower extremity. Careful assessment of the dimensions, location, patient comorbidities, availability of surrounding soft tissue and presence of adequate perforators are mandatory for proper perforator flap selection.
Perforator flap: A novel method for providing skin cover to lower limb defects
Medical journal, Armed Forces India, 2012
Background: Soft tissue defects in the lower limb pose a formidable challenge due to lack of reliable local flap options. Due to thin non-expendable soft tissues and predisposition to massive edema formation, even small defects become problematic. Perforator flaps represent the latest trends in soft tissue coverage. The aim of this study was to evaluate the effectiveness of perforator flaps as coverage of soft tissue defects in lower limbs. Material and methods: A series of patients with soft tissue defects of various etiologies in the lower limb were treated using perforator flap at a tertiary care service hospital. Six were free flaps and fourteen pedicled flaps. Doppler ultrasound was used to identify recipient and donor vessels pre-operatively. Results: Only one flap was lost due to venous congestion. In another case of carcinoma penis there was delayed healing due to persistent lymphorrhoea as a result of postoperative status following lymph node dissection and radiotherapy. Fifteen donor sites required split skin grafting, as they could not be closed directly. Conclusion: Perforator flaps are a reliable option for closure of soft tissue defects of lower limb irrespective of size, location and depth. There is minimal donor site morbidity. It has the advantage of rapid dissection, flap elevation and reliable skin territory. As no special equipment is required it can be replicated in smaller centers also.
Reverse Peroneal Artery Flap for Large Heel and Sole Defects: A Reliable Coverage
World journal of plastic surgery, 2017
Large soft tissue defects of ankle and foot always have been challenging to reconstruct. Reverse sural flaps, free flaps have been used for this problem with variable success. Reverse peroneal artery flap is an option to use with reliability without microvascular repair. Connections of peroneal artery around talus and ankle joint are deep and reliable with anterior tibial and posterior tibial artery. Arterial inflow and venous drainage improved with including short saphenous vein and reverse sural artery in the flap. Ten patients with large defects around heel underwent reconstruction with (RPAF) reverse peroneal artery flap (pedicled) over a period of 2 years. Final inset given after 18-21 days of primary surgery. The mean age of these patients was 45 years. Of the 10 flaps, all showed complete survival without even marginal necrosis. Two patients had minor donor site problems that settled with conservative management. RPAF is a very reliable flap for the coverage of large soft tis...
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2006
Compound fractures involving the leg, exposing the tibia or other poorly vascularised tissues such as tendons still pose a big problem for a reconstructive surgeon and they need early plastic surgical intervention. A prospective study of 10 cases of moderate sized defects in the leg exposing the tibia due to trauma was undertaken between January 2003 and August 2004 with an average follow up of 12 months. Pre-operative identification of the perforator around the wound was meticulously performed using hand held Doppler equipment. Most of the wounds were covered within the first 3-5 days of the injury. All the flaps were raised from the anterior or the lateral compartment of the leg to cover the adjacent tibial bone. Five flaps were raised as proximally based and five flaps were raised as distally based flaps. No flap was raised and advanced in a V-Y fashion. Split skin grafting was required in all cases to cover the secondary raw area created following the flap elevation. All flaps survived and served the purpose. In one case we encountered a deep seated infection resulting in sinus formation needing further debridement in the form of sequestrectomy. In conclusion, the authors believe that the perforator based flap cover described here is simple, safe and a versatile procedure for a trauma surgeon to cover the moderate sized traumatic pre-tibial wounds exposing the bone and the tendons.