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Distally based posterior tibial artery perforator flap for coverage of defects around the ankle, heel and lower third of leg

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

Reconstruction of distal leg region remained a difficult task. Free flaps had long been considered as a gold standard for these regions. However, due to various limitations of the free flap, a local fasciocutaneous flap could be considered as a good alternative. In this study, the use of a distally based posterior tibial artery perforator flap had been evaluated in the coverage of defects around the ankle, heel, and lower third of a leg. The study also outlined the donor-site morbidity and the technical details of the surgical procedure.

Methods

In this prospective study, a total of 42 patients with distal lower leg defects were included. The defects were located on the lower third of the leg (n = 23), ankle (n = 11), and heel (n = 8). Reconstruction was performed using distally pedicled posterior tibial artery perforator flaps. Patients were evaluated in terms of viability of the flap, functional gain, and donor-site morbidity. The technical details of the operative procedure have also been outlined.

Results

All the flaps survived well, with the exception of one patient, who experienced complete flap loss. Minor complications were, however, noted in four other patients: One patient developed superficial epidermolysis; one developed postoperative venous congestion, which subsided within 3 days by conservative means, and in two patients, partial loss of the skin graft occurred at the donor site but healed completely with dressing and antibiotics. The patients were followed up for an average period of 6 months, ranging from 1 to 13 months. Donor-site morbidity was minimal.

Conclusions

It was concluded that the distally based pedicled posterior tibial artery perforator flap was a reliable, easy, less time-consuming, and versatile procedure for covering the defects around the ankle, heel, and lower third a leg.

Level of Evidence: Level IV, therapeutic study

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Conflict of Interest

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Ethical Standards

This study has been approved by theappropriate ethics committee and have therefore been performed in accordancewith the ethical standards laid down in the 1964 Declaration of Helsinki and itslater amendments. All patients gave their informed consent prior to their inclusionin the study. Details that might disclose the identity of the subjects under studywere omitted.

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Authors and Affiliations

  1. Post Graduate Department of Burns, Plastic and Reconstructive Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India

    Md Sohaib Akhtar, M. Fahud Khurram, Rampukar Choudhary, A.H. Khan & Imran Ahmad

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  1. Md Sohaib Akhtar
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  2. M. Fahud Khurram
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  3. Rampukar Choudhary
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  4. A.H. Khan
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  5. Imran Ahmad
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Correspondence to Md Sohaib Akhtar.

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Akhtar, M., Khurram, M.F., Choudhary, R. et al. Distally based posterior tibial artery perforator flap for coverage of defects around the ankle, heel and lower third of leg. Eur J Plast Surg 37, 547–554 (2014). https://doi.org/10.1007/s00238-014-0998-5

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  • DOI: https://doi.org/10.1007/s00238-014-0998-5

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