J Reconstr Microsurg 2009; 25(2): 105-109
DOI: 10.1055/s-0028-1090616
© Thieme Medical Publishers

The Posterior Tibial Artery Perforator Flap: An Alternative to Free-Flap Closure in the Comorbid Patient

Brian M. Parrett1 , Jonathan M. Winograd2 , Samuel J. Lin1 , Loren J. Borud1 , Amir Taghinia1 , Bernard T. Lee1
  • 1Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Further Information

Publication History

Publication Date:
15 October 2008 (online)


Wounds of the distal third of the leg with exposed bone traditionally require free flaps for coverage. Although this often provides good results, patients with multiple comorbidities cannot undergo the long operating times and multiple surgical sites required for these complex procedures. We reviewed the use of posterior tibial (PT) perforator flaps as an alternative to free flaps for distal leg wound coverage in ill patients. Six patients (mean age, 53 years) with multiple comorbidities that precluded free-flap closures were treated with PT perforator flaps to cover complex distal leg wounds. The most common comorbidity was cardiac disease. Five patients had Gustilo grade IIIB open tibial fractures and one had a chronic wound. Mean flap size was 8 × 5.5 cm with a mean of one perforator per flap. Mean operating room time was 103 minutes. Four flaps were done without general anesthesia. There were no perioperative cardiopulmonary events. With a mean follow-up of 15 months, all flaps survived and all patients were ambulatory. There were no cases of malunion, nonunion, infection, wound breakdown, or partial flap loss. The PT perforator flap is a reliable choice for patients with open leg wounds and comorbidities precluding free-flap closure.


Bernard T Lee, M.D. 

Beth Israel Deaconess Medical Center, 110 Francis St.

Suite 5A, Boston, MA 02215

Email: blee3@bidmc.harvard.edu