Distal Fasciocutaneous Flaps of Lower Limb

Distally-based fasciocutaneous flaps from the lower limb provide a reconstructive option to cover small-to-moderate sized defects between the knee and ankle. Based on perforators from the posterior tibial, anterior tibial, or peroneal arteries, these flaps offer thin, pliable skin coverage without sacrificing major vessels.

Anatomy and Blood Supply

Fasciocutaneous flaps are designed over the gastrocnemius, soleus, or anterior/lateral leg skin territories, capturing distal perforators that traverse the fascia. The posterior tibial artery supplies the medial gastrocnemius and soleus flaps. The anterior tibial artery provides circulation for anterolateral leg flaps. Peroneal artery perforators nourish lateral gastrocnemius flaps.

Indications

Distal fasciocutaneous flaps provide durable and aesthetically matched coverage for small-to-moderate sized defects between the knee and ankle. They are ideal for trauma reconstruction, postoperative wound coverage, and filling dead spaces around fractures or hardware. The thin, pliable flaps contour well to the leg.

Surgical Technique

The defect size guides the flap design over the respective skin territory. After incision, flaps are gently elevated in the subfascial plane, preserving perforators. Dissection proceeds proximally until adequate perforator size and flow is confirmed. The flap is then transposed or rotated to the defect without tension. Skin grafting is often needed for donor site closure.

Advantages and Limitations

These flaps provide excellent color and contour match for leg defects. The avoidance of major vessel sacrifice and limited donor site morbidity are advantages over free tissue transfer. However, pedicle length and arc of rotation are limited. Defects requiring significant bulk or coverage beyond the mid leg may require alternate reconstructive options.

In summary, distally-based fasciocutaneous flaps enable single-stage reconstruction of small-to-moderate leg defects using local tissues with simplicity and low donor site morbidity. They should be considered as first-line options prior to considering free tissue transfer.