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DOI: 10.5999/aps.2012.39.4.360
Reconstruction of Pretibial Defect Using Pedicled Perforator Flaps
Background Coverage of defects of the pretibial area remains a challenge for surgeons. The difficulty comes from the limited mobility and availability of the overlying skin and soft tissue. We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps and free flaps on the pretibial area.
Methods Eight patients who had the defects in the anterior tibial area were enrolled. Retrospective data were obtained on patient demographics, cause, defect location, defect size, flap dimension, originating artery, pedicle length, pedicle rotation, complication, and postoperative result. The raw surface created following the flap elevation was covered with a split thickness skin graft.
Results Posterior tibial artery-based perforator flaps were used in five cases and peroneal artery-based perforator flaps in three cases. The mean age was 54.3 and the mean period of follow-up was 6 months. The average size of the flaps was 63.8 cm2, with a range of 18 to 135 cm2. There were no major complications. No patients had any newly developed functional deficit of the lower leg.
Conclusions We suggest that pedicled perforator flaps can be an alternative treatment modality for covering pretibial defects as a simple, safe and versatile procedure.
This article was presented at the 1st Research and Reconstructive Forum on May 12, 2011 in Daejeon, Korea.
Publication History
Received: 30 April 2012
Accepted: 12 June 2012
Article published online:
01 May 2022
© 2012. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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REFERENCES
- 1 Quaba O, Quaba A. Pedicled perforator flaps for the lower limb. Semin Plast Surg 2006; 20: 103-111
- 2 Salibian AH, Menick FJ. Bipedicle gastrocnemius musculocutaneous flap for defects of the distal one-third of the leg. Plast Reconstr Surg 1982; 70: 17-23
- 3 Fayman MS, Orak F, Hugo B. et al. The distally based split soleus muscle flap. Br J Plast Surg 1987; 40: 20-26
- 4 Moller-Larsen F, Petersen NC. Longitudinal split anterior tibial muscle flap with preserved function. Plast Reconstr Surg 1984; 74: 398-401
- 5 Taylor GI, Pan WR. Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg 1998; 102: 599-616
- 6 Taylor GI. The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg 2003; 30: 331-342
- 7 Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 2008; 122: 161-170
- 8 Sananpanich K, Tu YK, Kraisarin J. et al. Reconstruction of limb soft-tissue defects: using pedicle perforator flaps with preservation of major vessels, a report of 45 cases. Injury 2008; 39 (Suppl. 04) 55-66
- 9 Lu TC, Lin CH, Lin YT. et al. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011; 64: 386-393
- 10 Mateev MA, Kuokkanen HO. Reconstruction of soft tissue defects in the extremities with a pedicled perforator flap: series of 25 patients. J Plast Surg Hand Surg 2012; 46: 32-36
- 11 Koshima I, Moriguchi T, Ohta S. et al. The vasculature and clinical application of the posterior tibial perforator-based flap. Plast Reconstr Surg 1992; 90: 643-649
- 12 Rad AN, Singh NK, Rosson GD. Peroneal artery perforator-based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: case report and literature review. Microsurgery 2008; 28: 663-670
- 13 Saint-Cyr M, Wong C, Schaverien M. et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124: 1529-1544
- 14 Wong CH, Cui F, Tan BK. et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg 2007; 59: 672-678
- 15 Jakubietz RG, Jakubietz MG, Gruenert JG. et al. The 180-degree perforator-based propeller flap for soft tissue coverage of the distal, lower extremity: a new method to achieve reliable coverage of the distal lower extremity with a local, fasciocutaneous perforator flap. Ann Plast Surg 2007; 59: 667-671
- 16 Venkataramakrishnan V, Mohan D, Villafane O. Perforator based V-Y advancement flaps in the leg. Br J Plast Surg 1998; 51: 431-435
- 17 Yu P, Youssef A. Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap. Plast Reconstr Surg 2006; 118: 928-933
- 18 Masia J, Kosutic D, Cervelli D. et al. In search of the ideal method in perforator mapping: noncontrast magnetic resonance imaging. J Reconstr Microsurg 2010; 26: 29-35
- 19 Blondeel PN, Beyens G, Verhaeghe R. et al. Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 1998; 51: 202-209
- 20 Alonso-Burgos A, Garcia-Tutor E, Bastarrika G. et al. Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: imaging findings and initial experience. J Plast Reconstr Aesthet Surg 2006; 59: 585-593