The tibial and peroneal pedicled perforator flaps for reconstruction of the leg

Background: Soft tissue coverage of the leg was challenging due to some defect and usually required a free flap. Usage of a free�flap came with donor site morbidity, not only consuming considerable time but also requiring a facility for microsurgery. This�study reports findings regarding the pedicled perforator flap for the management of small- and medium-sized defects of the leg. Methods: From March 2011 to December 2019, 55 patients were treated with the pedicled�perforator flaps for leg defects. Defect size ranged from 2 � 3 cm to 6 � 14 cm. The flap was based on a single perforator of�the anterior tibial, posterior tibial, and peroneal arteries and was rotated 180�. The hand-held Doppler ultrasound and 320-slice computed tomography scanner were used preoperatively to determine the perforators in 37 and 18 cases, respectively. Results: Forty-two patients (76.4%) had flaps that completely survived,�and 11 patients (20%) developed partial flap necrosis, yet the flaps were still successful in covering the defects. One patient�(1.8%) developed partial flap necrosis but the flap did not succeed in covering the lesion, and 1 patient (1.8%) developed�total flap necrosis. Donor sites were closed primarily in 19 patients (34.5%) and were closed with small skin grafting in 36�patients (65.5%). The flap was based on a single perforator of the anterior tibial, posterior tibial, and peroneal arteries and was�rotated up to 180�. The operating time was from 90 to 150 min. The remaining flaps survived well with good aesthetic results. Conclusions: The�pedicled perforator flap is safe and reliable when used for the reconstruction of small to medium-sized leg defects. The�technique is convenient and less time-consuming while also minimizing donor site morbidity and providing good aesthetic�results. Level of evidence: Level IV, therapeutic study. � 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.