The perforators-chain island flap based on the saphenous artery and posterior tibial artery for covering skin defects in middle and distal lower leg

Objective To evaluate the clinical utility of perforators-chain island flap based on the saphenous artery and posterior tibial artery for covering soft tissue defects in middle and distal lower leg. Methods From April, 2012 to February, 2015, the perforators-chain island flaps based on the saphenous artery and posterior tibial artery were used reversely for covering soft tissue defects in middle and distal lower legs in 11 cases. With the assistance of doppler flowmeter, this perforators-chain island flap in the medial aspect of middle and distal thigh was designed to rotate at the perorating point of the posterior tibial artery perforator in the medial proximal crus, with the flap axis connecting the emerging points of perforators from saphenous artery and posterior tibial artery. The size of the flap ranged from 8.0 cm × 5.0 cm to 16.0 cm × 9.0 cm. The donor site was closed directly. Results All 11 flaps survived completely. No one lost to follow-up and the follow-up time varied from 3 to 18 months (mean, 8 months). All flaps were flat with good contour and texture. Satisfactory function and esthetic appearance were achieved in all patients. The two-point discrimination ranged from 6 to 10 mm. Only leaner scar was observed in the donor site and no disability of the knee joint was recorded during follow-up. Conclusion The perforators-chain island flap based on the saphenous artery and posterior tibial artery provides a practical option for covering soft tissue defects in the middle and distal lower leg. This flap is characteristiced by reliable blood supply without sacrificing main vessels, good contour and texture, satisfactory sensory recovery, conceal donor location, and minimal donor site morbidity with only leaner scar. Key words: Saphenous artery; Posterior tibial artery; Lower leg; Perforator flap; Microsurgical operation