Abstract
Background Significant lower limb wounds often require soft tissue coverage using vascularized
flaps. Traditionally, local muscles have been used for the proximal lower extremity
and free flaps for the distal leg and foot, but perforator flaps over the past decade
have been shown to be a reliable alternative.
Methods The evolution of our lower limb flap selection for the period 1996 to 2000 was retrospectively
compared with our current approach using perforator flaps. Flap selection was never
random, but based according to wound location, severity, and flap availability.
Results In the preperforator flap era, 101 of 122 (82.8%) flaps were muscle flaps. Over the
last 5 years, this relative usage decreased to 36.4%, whereas perforator flaps were
chosen almost half the time (49.6%). Local flaps still predominated as the choice
for the proximal lower limb, and free flaps more distally, with perforator free flaps
chosen twice as often as muscle flaps. Major complications occurred most commonly
in the more distal lower extremity and were related to microsurgical catastrophes
and not flap subtype.
Conclusions Perforator flaps can be another soft tissue choice for all zones of the lower extremity,
recognizing that function preservation is their major asset as no muscle need be included.
Peninsular, propeller, or advancement perforator flaps proved to be valuable local
nonmicrosurgical flap alternatives.
Keywords
perforator flaps - lower extremity zones - complex wound reconstruction
