title: Saphenous perforator flap for reconstructive surgery in the lower leg and the foot: a clinical study of 50 patients with posttraumatic osteomyelitis.
abstract: BACKGROUND
  The management strategies for reconstruction of soft-tissue defects of the lower leg and the foot remain disputed. To date, no comprehensive studies have been reported on the saphenous perforator flaps in reconstructive surgery in patients with posttraumatic osteomyelitis.
  
  
  METHODS
  Fifty patients with lower leg postinjury chronic osteomyelitis were included in a retrospective, noncontrolled clinical study conducted from 1995 to 2006. All study patients were managed by distally based saphenous neurofasciocutaneous perforator flaps, the feeding perforators originating from the tibial artery. An endpoint survey was conducted after flap surgery, mean follow-up period 4 years, response rate 60%.
  
  
  RESULTS
  Six patients had short-term flap failure (12%, 95% confidence interval: 5-24). An additional six patients had flap necrosis of <(1/4) that healed without surgical revision. Based on the endpoint data, the long-term success rate was 70% (95% confidence interval: 51-85). Three variables had impact on flap failure rates: the number of previous reconstructive operations, the identity of the performing surgeon, and the area of the primary defect. Other assumed risk factors had no statistically significant impact on short- or long-term results. The anatomic localization of the perforating arteries is described.
  
  
  CONCLUSIONS
  The saphenous perforator flap is a sturdy flap with low short-term failure rates, also in high-risk patients. The success rate compares well with results of free flap transfers in the management of posttraumatic osteomyelitis. The saphenous flap is a feasible option for posttraumatic reconstructions of osteomyelitis, especially in low-resource settings.
authors.affiliation: Institute of Clinical Medicine, Tromsoe University, Tromsø, Norway.
authors.forename: Tajsi
authors.initials: T
authors.lastname: Nenad
authors.forename: Winkel
authors.initials: W
authors.lastname: Reiner
authors.forename: Schlageter
authors.initials: S
authors.lastname: Michael
authors.forename: Hoffmann
authors.initials: H
authors.lastname: Reinhard
authors.forename: Husum
authors.initials: H
authors.lastname: Hans
mesh_terms: D000704:Analysis of Variance; D002908:Chronic Disease; D003646:Debridement; D005260:Female; D006085:Graft Survival; D006801:Humans; D007869:Leg Injuries / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000145:classification / Q000209:etiology / Q000601:surgery*; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply; D016909:Tibial Arteries / Q000637:transplantation*; D016896:Treatment Outcome; D014945:Wound Healing