A 5-YEAR REVIEW OF ISLANDED DISTALLY BASED FASCIOCUTANEOUS FLAPS ON THE LOWER-LIMB

The use of the distally based islanded fasciocutaneous flap is describ ed in 61 patients with lower limb defects and its application in cover age of compound fractures of the tibia is highlighted. A total of 66 f laps were raised from the posteromedial border of the leg, based on a single perforator off the posterior tibial artery. Flap coverage exten ded to include defects of the lower one third of the leg (n = 47) as w ell as the ankle, heel and foot (n = 4). Bony stabilisation was perfor med with a tibial intramedullary locking nail in 30 out of 53 fracture s; mean time to bony union was 5.9 months. Mean operating time was 1.7 hours and mean hospital stay was 25 days (range 8-98 days). Mean foll ow-up time was 13 months (maximum 5 years). Twenty-five flaps were use d to cover Gustilo IIIb fractures primarily, with a 20% complication r ate in this group. The flaps were used preferentially in males and in older females. The overall flap failure rate was 7.6%, with a further 10.6% of flaps suffering from tip necrosis and haematoma formation. Co ntributory factors to suboptimal healing included the presence of peri pheral vascular disease and heavy smoking.