title: Perforator flap: A novel method for providing skin cover to lower limb defects.
abstract: BACKGROUND
  Soft tissue defects in the lower limb pose a formidable challenge due to lack of reliable local flap options. Due to thin non-expendable soft tissues and predisposition to massive edema formation, even small defects become problematic. Perforator flaps represent the latest trends in soft tissue coverage. The aim of this study was to evaluate the effectiveness of perforator flaps as coverage of soft tissue defects in lower limbs.
  
  
  METHODS
  A series of patients with soft tissue defects of various etiologies in the lower limb were treated using perforator flap at a tertiary care service hospital. Six were free flaps and fourteen pedicled flaps. Doppler ultrasound was used to identify recipient and donor vessels pre-operatively.
  
  
  RESULTS
  Only one flap was lost due to venous congestion. In another case of carcinoma penis there was delayed healing due to persistent lymphorrhoea as a result of post-operative status following lymph node dissection and radiotherapy. Fifteen donor sites required split skin grafting, as they could not be closed directly.
  
  
  CONCLUSIONS
  Perforator flaps are a reliable option for closure of soft tissue defects of lower limb irrespective of size, location and depth. There is minimal donor site morbidity. It has the advantage of rapid dissection, flap elevation and reliable skin territory. As no special equipment is required it can be replicated in smaller centers also.
authors.affiliation: ADG (Med), O/o CIDS, New Delhi, India.
authors.forename: M K
authors.initials: MK
authors.lastname: Mukherjee
authors.affiliation: Senior Adviser Surgery and Recon Surgeon, Command Hospital, Pune 40, India.
authors.forename: M
authors.initials: M
authors.lastname: Alam Parwaz
authors.affiliation: Consultant Surgery, Command Hospital (SC), Pune 40, India.
authors.forename: B
authors.initials: B
authors.lastname: Chakravarty
authors.affiliation: Associate Professor, Dept of Surgery and Plastic Surgery, Armed Forces Medical College, Pune 40, India.
authors.forename: V
authors.initials: V
authors.lastname: Langer
keywords: Lower limb reconstruction; Perforator flaps; Soft tissue coverage; Wounds and injuries