Reconstruction of Distal Limb Defects with Multiple Individualized Free Perforator Flaps

Introduction: Soft tissue defects of distal limb are very common in various injuries, which always need an individualized flap to resurface. Many perforator flaps can be transferred to repair them, but it still may be difficult to decide which one is the best option for the recipient site reconstruction. The purpose of this article is to study the selection strategy of the donor site where the free perforator flap is raised for the defect of distal limb.

Methodology and Material: From April 2006 to July 2013, 223 patients with skin soft tissue defects of distal limbs were reconstructed with versatile free perforator flaps. In this series, there were 91 anterolateral thigh perforator flaps (ALTP), 36 medial sural artery perforator flaps (MSAP), 38 peroneal artery perforator flaps (PAP), 23 posterior interosseous artery perforator flaps (PIAP), 17 superficial circumflex iliac artery perforator flaps (SCIP), 13 lateral arm perforator flaps (LAP), 5 Foot medial perforator flaps (FMP). The individual flap selection was based on the similar thickness, texture and color to the recipient cites, at the same time primary close in donor sites should be achieved.

Results: 207 flaps survived uneventfully. 7 had blisters and partially purple, which survived after removing partial sutures. 5 were salvaged successfully from vascular compromise with the second look surgery. 4 flaps were necrosis. The clinical results were satisfactory after 6-25 months of following-up， and the scars at the donor site were not obvious.

Conclusions: The free perforator flap had a reliable blood supply and high survival rate. Flap selection depended on the features of soft tissue defect and the morbidity of the donor site.