Versatility and "flap efficiency" of pedicled perforator flaps in lower extremity reconstruction.
BACKGROUND
The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects.


METHODS
Between April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps. We performed 16 pedicled reverse-flow anterolateral thigh (RF-ALT) flaps, 8 pedicled medial sural artery perforator (MSAP) flaps, 26 pedicled peroneal artery perforator (PAP) flaps, and 11 pedicled posterior tibial artery perforator (PTAP) flaps. Digital planimetry of defects covered was analyzed and the "efficiency" of each flap was calculated, which allowed the assessment of the merits of each flap in the management of lower limb defects.


RESULTS
Flaps healed primarily in 82% of cases (50/61). Approximately 50% of the secondary donor sites required skin grafting. Complications requiring secondary surgery occurred in 18% (11/61) of the cases. Six required secondary skin grafting (10%). One RF-ALT flap was converted into a free flap, one PAP required arterial supercharging, and three pedicled RF-ALT flaps required venous supercharging. Image analysis showed that these pedicled perforator flaps could cover 75% of the surface area of the lower leg. The higher length of perforator allowed for greater "flap efficiency" and better versatility of tissue cover.


CONCLUSIONS
Image analysis can be used as a modality to assess the versatility of individual flaps in the reconstruction of lower limb defects.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan; Plastic Surgery Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
Jason K F
JK
Wong
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.
Nidal
N
Deek
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.
Chung-Chen
CC
Hsu
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.
Hsin-Yu
HY
Chen
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.
Chih-Hung
CH
Lin
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan; Center for Vascularized Composite Allotransplantation, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address: lukechlin@gmail.com.
Cheng-Hung
CH
Lin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Anterolateral thigh flap; Defect; Medial sural artery perforator flap; Pedicled perforator flap; Peroneal artery perforator flap; Posterior tibial artery perforator flap