PERFORATOR MAPPING OF MAIN VASCULAR AXES OF LOWER LIMB AND ITS CLINICAL APPLICATION IN RESURFACING MIDDLE AND LOWER THIRD LEG DEFECTS - A PROSPECTIVE STUDY.

Dr. Prabir Kumar Jash; DR. MAINAK MALLIK; DR. SANTANU SUBA; DR. DEEPANJAN DEY; DR. TAJENDRA SINGH

Volume : VIII, Issue : II, February - 2019

PERFORATOR MAPPING OF MAIN VASCULAR AXES OF LOWER LIMB AND ITS CLINICAL APPLICATION IN RESURFACING MIDDLE AND LOWER THIRD LEG DEFECTS - A PROSPECTIVE STUDY.

Dr. Prabir Kumar Jash, Dr. Mainak Mallik, Dr. Santanu Suba, Dr. Deepanjan Dey, Dr. Tajendra Singh

Abstract :

CONTEXT– With the concept of perforators and angiosomes, locoregional tissues can be transferred, based on a reliable perforator, the flaps being islanded or propelled into the defect in the middle and lower third defects of the lower limb.

AIM– We aimed to study the location and number of perforators of the 3 vascular axes of the lower limb preoperatively with hand held doppler, assess intraoperative confirmation and design flaps accordingly to resurface middle and lower third defects of lower limb.

METHODOLOGY– 30 patients with soft tissue defects of the middle and/or lower third of lower limbs were resurfaced with perforator flaps during which the perforators were mapped, the flaps designed and executed noting the complications at Medical College, Kolkata, India over 2 years.

RESULTS – 66.67% flaps were of islanded propeller types. The maximum flap size was 15X9 cm. 41% peroneal perforators were located in 13–18 cm interval, 30% posterior tibial perforators in 21–26 cm interval and 33% anterior tibial perforators in 4–9 cm interval, distance being measured from inter–malleolar line. 8.33% flap loss due to congestion occurred. Complications decreased as perforators placed more distant to the defect were taken.

CONCLUSION– Soft tissue defects in middle and lower third of small to moderate size in lower limb can be safely resurfaced with perforator flaps with the selection of a reliable perforator.