Non-microsurgical skin flaps for reconstruction of difficult wounds in distal leg and foot

Abstract

Purpose: To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique.

Methods: Altogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap (n = 8), distally based peroneal artery perforator flap (n = 4), distally based sural flap (n = 6), medial planter artery flap (n = 2) and cross leg flaps (n = 6).

Results: In all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis.

Conclusion: Would at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.

Keywords: Cross leg flaps; Foot; Local flaps; Lower third of leg.

Fig. 1

Severe trauma to the lower third of leg and ankle joint with exposure of bone and hardware and coverage by posterior tibial artery perforator flap. A: Exposure of bone and hardware; B: X-ray showed multi fragmentary fracture with multiple fixation; C: Rotation and in setting of the flap; D: Complete healing of the flap (5 months postoperative).

Fig. 2

Exposure of previously repaired tendoachilles and coverage by posterior tibial artery perforator flap. A: Exposure of repaired tendoachilles (3 months ago); B: Coverage by posterior tibial artery perforator flap (3 months postoperative).

Fig. 3

Exposure of bone in lateral side of right lower leg and ankle joint and coverage by peroneal artery perforator flap. A: Degloved lateral side of leg and exposure of bones of the ankle joint; B: X ray showed fractures of tibia and ankle bones; C: Elevation of the flap with dissection of peroneal artery and its perforator; D: Healing of peroneal artery perforator flap (8 months postoperative); E: X ray showed healing of bone (8 months postoperative).

Fig. 4

Exposure of chronic ulcer of heel of right leg covered with distally based sural flap. A: Exposure of heel; B: Early postoperative; C: Postoperative view after 6 months.

Fig. 5

Exposure of chronic ulcer of heel due to myelomeningocele of right leg covered with medial planter flap. A: Chronic ulcer of heel; B: Excision of ulcer; C: Perforators of medial planter artery; D: Postoperative view of flap after 6 months; E: Postoperative view of donor site after 6 months.

Fig. 6

Severe trauma to right foot after motor car accident with exposure of hardware. A: Exposed dorsum of right foot; B: X ray of right foot showing severe trauma to the bones of the foot; C: Cross leg flap; D: Healing of the flap (3 months postoperative).

Fig. 7

Chronic ulcer on the lateral side of right lower leg since 20 years with history of failed skin grafts (7 times before). A: Chronic ulcer on the lateral side of right lower leg; B: Debridement of the ulcer; C: Cross leg flap; D: Healing of the flap with partial distal necrosis (2 months postoperative).