PERFORATOR FLAPS FOR RECONSTRUCTION OF LOWER LIMB DEFECTS
DOI:
https://doi.org/10.32553/ijmbs.v4i10.1516Keywords:
Perforator flaps, Propeller flaps, Lower limb reconstruction, Lower third leg reconstructionAbstract
Background: Reconstruction of soft tissue defects in the lower third of the leg remains challenging. Anatomical constraints limit the local options available for complex defects especially lower third of leg. Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. We present our experience with perforator flaps for reconstruction of soft tissue defects in the lower limb.
Methods: This prospective cross-sectional study was carried out in the Department of Burn and Plastic Surgery at Government Medical College and Hospital, Bettiah, Bihar, India from jan 2018 to August 2018. Total 20 patients with lower limb defects treated with various perforator flaps (both elective as well as emergency) were included in the study. A hand-held Ultrasound Doppler was used preoperatively and intra-operatively to detect the perforator vessels.
Results: Out of 20 patients, 6 patients in our study developed complications, out of which 3 patients had minor complications which included infection, wound dehiscence and congestion of flap. These patients did not require any secondary procedure and were managed conservatively. We witnessed partial flap loss in one and distal flap necrosis in two patients. In one of these three cases, the flap was repositioned to its native site, due to suspected colour changes intra-operatively and later after 3 days was successfully positioned on the desired site. The other two cases were managed with VAC and later STSG.
Conclusions: Perforator flaps may represent a good alternative to the free flaps in the areas were other local reconstructive procedures are not possible. This is a versatile technique and with decreased donor site morbidity limited to a single body area. There is a specific like to like soft tissue replacement leading to a better cosmetic and reconstructive outcome. The main drawback of the perforator flaps however is the higher risk of venous congestion.
Keywords: Perforator flaps, Propeller flaps, Lower limb reconstruction, Lower third leg reconstruction
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