Reconstruction of Pretibial Defect Using Pedicled Perforator Flaps

Overview

Journal Arch Plast Surg

Specialty General Surgery

Date 2012 Aug 9

PMID 22872840

Citations 5

Authors

In Soo Shin

Dong Won Lee

Dong Kyun Rah

Won Jai Lee

Affiliations

Soon will be listed here.

Abstract

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 cm(2), with a range of 18 to 135 cm(2). 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.

Citing Articles

Perforator-based Adipofascial Flaps and ADM: A Novel Combined Approach to Distal Lower Extremity Defects.

Losco L, Sereni S, Aksoyler D, Spadoni D, Bolletta A, Cigna E Plast Reconstr Surg Glob Open. 2022; 10(2):e4131.

PMID: 35198355 PMC: 8856593. DOI: 10.1097/GOX.0000000000004131.

Pedicled perforator flaps for mid-tibial soft tissue reconstruction in medically compromised patients.

Jakubietz R, Schmidt K, Holzapfel B, Meffert R, Jakubietz M JPRAS Open. 2020; 24:47-55.

PMID: 32346592 PMC: 7182687. DOI: 10.1016/j.jpra.2020.02.002.

Pedicled Peroneal Artery Perforator Flap for Knee Defect Reconstruction: Case Presentation and Literature Discussion.

Alshomer F, Alhujayri A, Althubaiti G Plast Reconstr Surg Glob Open. 2019; 6(11):e2034.

PMID: 30881814 PMC: 6414094. DOI: 10.1097/GOX.0000000000002034.

Perforator Flap versus Conventional Flap.

Kim J, Kim S J Korean Med Sci. 2015; 30(5):514-22.

PMID: 25931780 PMC: 4414633. DOI: 10.3346/jkms.2015.30.5.514.

Internal pudendal perforator artery-based gull wing flap for vulvovaginal 3D reconstruction after tumour excision: a new flap.

Han H, Jun D, Seo B, Moon S, Oh D, Ahn S Int Wound J. 2015; 13(5):920-6.

PMID: 25586284 PMC: 7949897. DOI: 10.1111/iwj.12410.

References

Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich R . The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg. 2009; 124(5):1529-1544. DOI: 10.1097/PRS.0b013e3181b98a6c. View

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(4):928-933. DOI: 10.1097/01.prs.0000232216.34854.63. View

Jakubietz R, Jakubietz M, Gruenert J, Kloss D . 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(6):667-71. DOI: 10.1097/SAP.0b013e31803c9b66. View

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(1):161-170. DOI: 10.1097/PRS.0b013e3181774386. View

Wong C, Cui F, Tan B, Liu Z, Lee H, Lu C . Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg. 2007; 59(6):672-8. DOI: 10.1097/SAP.0b013e31803df4e9. View

Rad A, Singh N, Rosson G . Peroneal artery perforator-based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: case report and literature review. Microsurgery. 2008; 28(8):663-70. DOI: 10.1002/micr.20557. View

Taylor G, Pan W . Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg. 1998; 102(3):599-616; discussion 617-8. View

Masia J, Kosutic D, Cervelli D, Clavero J, Monill J, Pons G . In search of the ideal method in perforator mapping: noncontrast magnetic resonance imaging. J Reconstr Microsurg. 2009; 26(1):29-35. DOI: 10.1055/s-0029-1238222. View

Mateev M, Kuokkanen H . Reconstruction of soft tissue defects in the extremities with a pedicled perforator flap: series of 25 patients. J Plast Surg Hand Surg. 2012; 46(1):32-6. DOI: 10.3109/2000656X.2011.634562. View

10.

Taylor G . The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg. 2003; 30(3):331-42, v. DOI: 10.1016/s0094-1298(03)00034-8. View

11.

Venkataramakrishnan V, Mohan D, Villafane O . Perforator based V-Y advancement flaps in the leg. Br J Plast Surg. 1998; 51(6):431-5. DOI: 10.1054/bjps.1997.0229. View

12.

Lu T, Lin C, Lin C, Lin Y, Chen R, Wei F . Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg. 2010; 64(3):386-93. DOI: 10.1016/j.bjps.2010.05.004. View

13.

Petersen N . Longitudinal split anterior tibial muscle flap with preserved function. Plast Reconstr Surg. 1984; 74(3):398-401. DOI: 10.1097/00006534-198409000-00012. View

14.

Salibian A, Menick F . Bipedicle gastrocnemius musculocutaneous flap for defects of the distal one-third of the leg. Plast Reconstr Surg. 1982; 70(1):17-23. DOI: 10.1097/00006534-198207000-00005. View

15.

Alonso-Burgos A, Garcia-Tutor E, Bastarrika G, Cano D, Martinez-Cuesta A, Pina L . 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(6):585-93. DOI: 10.1016/j.bjps.2005.12.011. View

16.

Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A . The vasculature and clinical application of the posterior tibial perforator-based flap. Plast Reconstr Surg. 1992; 90(4):643-9. DOI: 10.1097/00006534-199210000-00014. View

17.

Fayman M, Orak F, Hugo B, Berson S . The distally based split soleus muscle flap. Br J Plast Surg. 1987; 40(1):20-6. DOI: 10.1016/0007-1226(87)90005-1. View

18.

Blondeel P, Beyens G, Verhaeghe R, Van Landuyt K, Tonnard P, Monstrey S . Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg. 1998; 51(3):202-9. DOI: 10.1016/s0007-1226(98)80010-6. View

19.

Sananpanich K, Tu Y, Kraisarin J, Chalidapong P . Reconstruction of limb soft-tissue defects: using pedicle perforator flaps with preservation of major vessels, a report of 45 cases. Injury. 2008; 39 Suppl 4:55-66. DOI: 10.1016/j.injury.2008.08.032. View