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 x 3 cm to 6 x 14 cm. The flap was based on a single perforator of the anterior tibial, posterior tibial, and peroneal arteries and was rotated 180 degrees. 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 degrees. 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.