Novel fasciocutaneous flaps for the reconstruction of complicated lower extremity wounds

Summary: Reconstruction of the leg is particularly challenging especially when the defect involves its lower third. The options for lower leg reconstruction are very few because of the lack of local soft tissue available for transfer. Novel fasciocutaneous flaps nourished by perforator vessels have been developed and are increasingly used as a valuable local alternative to the local flaps, with their high complication rates, and to the microsurgical flaps, with their more difficult and specialized technique. They provide local tissue, replacing like with like, but they harvest it from a distant, undamaged, region of the leg, which means healthy and well-vascularized tissue. They do not need microsurgical facilities and skills, which may not be available everywhere. However, it is vital that the vessels are handled with great care and meticulous attention to detail in their preparation for the rotation. The known anatomic exiting sites of the perforator from the fascial plane will guide the planning of the flap, aided by the Doppler ultrasound and an exploratory incision. the surgical technique of perforator flaps harvesting and flap design, complications and solutions will be discussed here. Fasciocutaneous perforator flaps can be used as an elegant alternative to other local or free flaps to treat the loss of tissues of the leg, once risk, benefits and expected results are understood.