Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects

Lu, Ting-Chen; Lin, Chih-Hung; Lin, Yu‐Te; Chen, Ruei-Feng; Wei, Fu‐Chan

doi:10.1016/j.bjps.2010.05.004

Cited by 91 publications

(89 citation statements)

References 27 publications

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“…The constant septocutaneous perforators arising from the middle to distal third of the leg allowed for raising of flaps well suited for covering for distal half of the lower leg and ankle region. 9 There was usually at least one reliable dominant perforator that could be used in keeping with reported anatomical studies 3 We used propeller flaps most frequently. These flaps have high versatility to reach difficult-to-cover areas such as lateral malleolus, Achilles tendon, and dorsum of foot.…”

Section: Discussionmentioning

confidence: 99%

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Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Wong

Deek

Hsu

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Summary Background: The 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 methods: Between 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 was analyzed and the "efficiency" of each flap was calculated, which allowed the assessment of the merits of each flap in the management of lower limb defects. Results: Flaps 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 flap was converted into a free flap, one PAP required arterial supercharging, and three pedicled RF-ALT flaps required venous supercharging. Image analysis showed that these pedicled perforator flaps could cover 75% of the surface area of the lower leg. The higher length of perforator allowed for greater "flap efficiency" and better versatility of tissue cover.

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Section: Discussionmentioning

confidence: 99%

“…In addition, they are less bulky, and are thought to have less associated risk than free flaps, as microsurgical anastomosis is not required. 9 The use of PPFs also offer a comparable, "like for like" tissue type for reconstruction. However, perforator dissection is not universally practiced by all reconstructive surgeons.…”

Section: Introductionmentioning

confidence: 99%

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Wong

Deek

Hsu

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…10 Reverse sural artery flap was regarded as a type A fasciocutaneous flap by Morgan et al, but the flap in this study should belong to a type B fasciocutaneous flap according to the classification introduced by Cormack and Lamberty, because there is a single sizeable fasciocutaneous perforator of peroneal artery contained at the base of the flap. 11,12 The flaps harvested in this study are similar to perforator-plus fasciocutaneous flap described by Mehrotra and peninsular pedicled peroneal arterial perforator flap described by Lu et al 13,14 The flaps have characteristics of both perforator flaps and fasciocutaneous flaps in which length -width ratio plays an important role in viability of the flaps. These flaps obtain dominant blood supply from the perforators of the peroneal vessels; Width of the base of flap is associated with arterial supply and venous drainage.…”

Section: Discussionmentioning

confidence: 71%

Distally based reverse sural artery flap as an interpolation flap

Muppireddy

Srikanth

2016

Int J Res Orthop

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Background: Coverage of soft tissue defects of the foot and ankle has imposed a challenging situation to the plastic surgeon. Some patients have contraindications for microsurgery, thus limiting the options for local tissue transfer. The Reverse sural artery flap is frequently used for reconstruction of distal third leg, ankle, and heel. The major disadvantage of RSA flap is compression of pedicle within subcutaneous tunnel leading to venous congestion and distal flap necrosis. To overcome this problem, we describe an interpolation flap technique in which subcutaneous tunneling of neurovascular structures is avoided. Methods: 13 cases of distally based RSA flaps as interpolation flap were performed for soft tissue defects in dorsum of foot, heel pad, malleoli, and TA region during the period 2014 to 2016. Results: With this procedure no flap loss was observed in this series and only a few minor complications occurred. The pedicle is divided in a second stage operation. Conclusions: We conclude that transferring the flap in 2 stages without use of tunnel improves the reliability of flap and decreases the chances of necrosis.

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“…In addition to the distal leg and foot coverage, perforator flaps have been increasingly used in the coverage of mid-and proximal defects of the leg, for which local muscle flaps or free flaps were once used (9,12,15). In 1 patient, we used both a posterior tibial artery perforator flap and a peroneal artery posterior perforator adipose flap to cover a large mid-tibial defect, because no healthy recipient vessels were available for free tissue transfer (Fig.…”

Section: Discussionmentioning

confidence: 97%

“…The flaps can be very versatile in preparation and transfer to meet specific needs and increase viability (12). The several modifications we used with our patients included flap delay, propeller style transfer, flip style transfer, adipofascial harvest, and "adipose only" harvest without the muscle fascia (Table 1 and Figs.…”

Section: Discussionmentioning

confidence: 99%

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

Acartürk

Tunc

Acar

2016

The Journal of Foot and Ankle Surgery

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Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects

Cited by 91 publications

References 27 publications

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Distally based reverse sural artery flap as an interpolation flap

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

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