Bipedicle fasciocutaneous flaps for inframalleolar vascular graft coverageat the ankle/foot

In 9 patients requiring inframalleolar bypass (11 extremities), intraoperat ive consult revealed exposed saphenous vein grafts at either the medial ank le or the dorsum of the foot in which primary wound closure resulted in the reduction or occlusion of blood flow. In these patients, longitudinally or iented bipedicle fasciocutaneous flaps were raised with widths of 3 to 4 cm and lengths ranging from 12 to 18 cm, with Doppler confirmation of discret e fascial perforators. Split-thickness skin grafts were placed in the wake of the flaps. Patient follow-up ranged from 2 to 78 months. All wounds heal ed, and 10 of 11 limbs were salvaged. Bipedicle flap coverage allows recons truction of soft-tissue defects with the transposition of local tissues of similar qualities, avoiding the need for more complex distant tissue recons truction. The inclusion of the deep fascia with the flap enhances its vascu lar perfusion, even in the ischemic lower extremity, with concurrent revasc ularization. The reliability of this type of flap is not dependent on tradi tional concepts of length-to-width ratios, but rather on standard principle s of angiosome anatomy.