Perforator-base flaps for closure of wound at ankle and distal tibia
INTRODUCTION: Perforators flap has gained popularity recently in lower limb trauma as reliable methods soft tissue coverage in the distal tibia. It is based on the concept of angiosome that was introduced by Taylor in 1987 to describe the territory of skin supply by perforators. The aim of this st...
| Main Authors: | , |
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| Format: | Conference or Workshop Item |
| Language: | English English |
| Published: |
2015
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/43292/ http://irep.iium.edu.my/43292/ http://irep.iium.edu.my/43292/1/Evidence_from_Event_Booklet_-_Dr.Nazri.pdf http://irep.iium.edu.my/43292/2/Perforator-Base_Flaps_POSTER.png |
| Summary: | INTRODUCTION:
Perforators flap has gained popularity recently in lower limb trauma as reliable methods soft tissue coverage in the distal tibia. It is based on the concept of angiosome that was introduced by Taylor in 1987 to describe the territory of skin supply by perforators. The aim of this study is to describe the surgical technique and the outcome using this flap in orthopaedic patients.
MATERIALS & METHODS:
We reported 6 cases of the use of perforator base flap for the wound coverage of the distal tibia. All were males with mean age of 36 years old (range 8-69). 2 cases were due to open fracture dislocation of ankle, 2 open fracture grade IIIB distal tibia and 2 infected open fracture.
RESULTS:
All flaps survive with no congestion or necrosis.
Figure1: Location of the perforator (red arrow) that will become the pivot point of the flap
Figure 2: The leg after raising of the perforator flap. the donor site can be partially sutured and skin grafted.
DISCUSSIONS:
Exposed bone, joint and tendon require flap coverage to prevent desiccation and infection. With the help of hand held Doppler, surgeon can identify the perforators and reliably plan the flap design to raise a pedicle flap base on this perforator. This knowledge is also important for orthopaedic surgeon to plan their incision so that he does not “kill” the future flap when the patients need it. It is vital not to extend the wound vertically beyond one cm from the medial border of tibia during debridement. The main disadvantage is the flap can only be use to cover small defect.
CONCLUSION:
The use of local perforator-base flaps for reconstruction of soft tissue defects of the distal tibia is a simple and safe alternative to cover small defect at distal tibia.
REFERENCES:
1. Taylor GI, Corlett RJ, Dhar SC,Ashton MW. The anatomical (Angiosome) and clinical territories of cutaneous perforating arteries: Development of the concept and designing safe flaps. Plast Reconstr Surg.2011; 127:1447- 59
2. Quaba O, Quaba A. Pedicled perforator flaps for the lower limb. Semin Plast Surg. 2006; 20: 103-11
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