The Use of Supermicrosurgery in Lower Extremity Reconstruction: The Next Step in Evolution

Background: The purpose of this study was to evaluate the feasibility of super-microsurgery (perforator-to-perforator anastomosis) in lower extremity reconstruction. Methods: From January of 2007 to February of 2008, a total of 42 patients were treated for soft-tissue defects of the lower extremity resulting from various causes. They were reconstructed with either anterolateral thigh perforator flaps (38 flaps) or upper medial thigh perforator flaps (four flaps) using the super-microsurgery technique. The region of the defect was located on the knee, including the upper third of the leg in 17 patients and the middle third of the leg in 25 patients. All of the flaps were anastomosed between the perforators in end-to-end fashion. Results: With the exception of one flap, all flaps survived without any complications. One flap was observed to have no flow after 24 hours and was deemed unsalvageable. The average time of operation was 3 hours 20 minutes. Ambulation was allowed within 7 days after surgery if bone status was feasible. Conclusions: The use of supermicrosurgery in lower extremity reconstruction allows an increase in selection of recipient pedicles. By using a perforator-to-perforator anastomosis approach, less time is consumed in securing the recipient vessel and elevating the flap, and the risk for major vessel injury is minimized and flap survival is acceptable. However, it requires a steep learning curve before the technique can be used comfortably. The supermicrosurgery technique is feasible and may be efficient in the hands of a skilled surgeon. (Plast. Reconstr. Surg. 123: 230, 2009.)