Transversally oriented pedicled perforator flaps: A reliable alternative for lower leg reconstruction

Background: The use of a transverse pattern for perforator flap design and its possible clinical applications in the field of lower leg reconstructionare previously unreported in the medical literature. The purpose of this report is to describe our clinical experience with the useof transversally oriented pedicled perforator flaps in lower leg reconstruction. Patients and methods: Seven patients underwent lower legreconstruction with transversally oriented pedicled perforator flaps. Patients age ranged from 42 to 68 years. All defects resulted from skincancer ablation. Defect sizes ranged from 9 3 5 to 5 3 2.5 cm. The technique was applied to patients presenting with vertically oriented,long, and narrow defects, not feasible for primary closure, with the only audible perforators detected at a significant distance from thewound. Results: All flaps were based on a single perforator vessel. One of them was converted to a perforator-plus peninsular flap design,which retained an additional source of blood supply from the opposite skin bridge. The flaps were always mobilized in V-Y fashion. Donorsites were always closed primarily. Flap dimensions ranged from 15 3 7 to 8 3 3.5 cm. Operative time ranged from 40 to 90 minutes. Allflaps survived uneventfully. Follow-up ranged from 6 months to 2 years. All patients were satisfied with the surgical outcome. Conclusions:The use of transversally oriented pedicled perforator flaps proved to be a reliable alternative option to reconstruct small to medium sizedefects of the lower leg.