A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

Abstract

Lower extremity soft tissue defects frequently result from high-energy trauma or oncological resection. The lack of suitable muscle flap options for the distal leg and foot makes defects in these locations especially challenging to reconstruct and free tissue transfer is commonly used. Another option that has become more popular in the past two decades are pedicled perforator flaps. Based on a thorough literature review and the authors’ experience on leg perforator flaps for over a decade, this article presents a historical review, the anatomical basis of common perforator flaps of the leg and foot, patient selection, wound selection, perforator selection, flap design, surgical techniques, refinements, and postoperative care. A review of the clinical outcomes and complications of these flaps was also performed and was noted to be comparable to the outcomes of free tissue transfer with significantly lower total flap failure rate. It is hoped that this review will assist surgeons in the formulation of a comprehensive step-by-step guide in performing pedicled perforator flap reconstruction of the lower extremity.

Use of locoregional Perforator Flaps for reconstruction of lower limb defects: Our experience

“…Despite the complications, majority of perforator flaps were noted to survive, & secondary surgery is rarely required. (10) In our study over all flap survival rate was 90.9% which is comparable with Lazzeri et al in which it was 80.7%. (11)…”

Efficacy of the Free-Style, Perforator-Plus Flap in the Reconstruction of the Soft Tissue Defects at the Lower Leg and Ankle Regions

“…One patient only was diabetic controlled on insulin. More details about demographic and presentations are shown in Table (1). Perforator system: Posterior Tibial Artery (PTA) perforator system was used in (70% of cases) with pivot point from medial malleolus tip range from 9 to 20cm (Mean 12±2.9 SD cm), Peroneal Artery (PA) perforator system was used (20%) with a pivot point from lateral malleolus tip range from 6 to 14cm (Mean 11±3.6 SD cm), and Anterior Tibial Artery (ATA) perforator system was used in 2 cases only (10%) with a pivot point from lateral malleolus tip 13 and 17cm.…”

“…Reconstruction of the lower leg and ankle soft tissue defects is not that the convenient task, mostly, due to the inherent anatomy: The decreased bulk of the soft tissues and the subcutaneous bony aspect [1]. Vascularity is also an important aspect on the level of the main vessels, and indeed on the level 219 of the perforators, which have variant numbers, sites, lengths, and diameters, even in the same person on the opposite sides [2,3].…”

“Like For Like” Reconstruction of Heel Pad with Medial Plantar Artery Flap—Functional and Aesthetic Outcomes in A Series of 19 Cases

“…MPA, the nondominant branch of PTA, divides into superficial and deep branches 6 7 8 approximately 2.5 to 3.5 cm from its origin, deep to AbdH muscle. Based on superficial branch of MPA running in the medial intermuscular septum (MIS), instep flap can be elevated as either a proximally based flap or a distally based flap.…”