Perforator-sparing transposition flaps for lower limb defects: anatomic study and clinical application.

The local fasciocutaneous flap has the advantage of low donor-site morbidity when used for the coverage of lower limb defects. However, flap reliability remains a major problem with its use. The purpose of this study was to determine the feasibility of preserving perforators to the tip of conventional local fasciocutaneous flaps to improve its vascularity. The technical considerations of raising these flaps were examined in cadaveric specimens. Twenty-one local perforator-sparing transposition flaps were raised in 12 specimens. The leg was divided into knee/proximal-third, middle-third, and lower-third/ankle regions. We raised 7 flaps in each region. Success was defined as ability to transpose flaps to cover defects without tension on the perforators. In the knee/upper-third and middle-third regions of the leg, all wounds were successfully closed. However in the lower-third and ankle region, we were unable to close wounds in 3 of 7 cases. The reasons for this were the inadequate length of the perforator and the presence of tendons in the distal leg that interfered with perforator transposition. We successfully employed this flap in 6 clinical cases. This flap represents a technical advancement over conventional lower limb skin flaps because of its improved vascularity. It can safely be performed in the knee and upper and middle-thirds of the leg and can potentially be a valuable alternative to local muscle flaps for wounds in these areas.