Versatility and “flap efficiency” of Pedicled Perforator Flaps in Lower Extremity Reconstruction

Publication date: Available online 5 October 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): J.K.F. Wong, N. Deek, C.C. Hsu, H.Y. Chen, C.H. Lin, C.H. Lin
BackgroundThe use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects.Patients and MethodsBetween April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps. We performed 16 pedicled reverse-flow anterolateral thigh (RF-ALT) flaps, 8 pedicled medial sural artery perforator (MSAP) flaps, 26 pedicled peroneal artery perforator (PAP) flaps, and 11 pedicled posterior tibial artery perforator (PTAP) flaps. Digital planimetry of defects covered were analysed and the "efficiency" of each flap was calculated which allowed the merits of each flap in the management of lower limb defects to be assessed.ResultsFlaps healed primarily in 82% of cases (50/61). Approximately 50% of the secondary donor sites required skin grafting. Complications requiring secondary surgery occurred in 18% (11/61) of the cases. Six required secondary skin grafting (10%). One RF-ALT was converted into a free flap, one PAP required arterial supercharging and three pedicled RF-ALT flaps required venous supercharging. Image analysis calculated these pedicled perforator flaps could cover 75% of the surface area of the lower leg. The greater length of perforator allowed for greater "flap efficiency" and better versatility of tissue cover.ConclusionImage analysis can be used as a modality to assess the versatility of individual flaps in the reconstruction of lower limb defects.



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