Two Decades as Witness to the “Rise” of Local Perforator Flaps, and the “Demise” of Free Flaps for Lower Extremity Reconstruction?

Geoffrey G . Hallock, M .D. ∞ Allentown, Pennsylvania, U.S.A. ∞ gghallock@hotmail.com

Hypothesis: Local perforator flap options have replaced the need for lower extremity free flaps.

 

Materials: Over 20 years, 418 (58%) free flaps, 221 (31%) local perforator, and 80 (11%) local muscle flaps were selected for soft tissue coverage in all lower extremity zones

 

Results: 1.Perforator flaps, whether local or free, were the dominant flap choice in all intervals to preserve function whenever possible [Chart 1.].

2.Only in the last 5-years did local perforator flaps exceed use of free flaps [Chart 2.].

3.Local muscle flap selection diminished eventually almost to naught [Chart 2.].

4.Local perforator flaps could be used in every zone of the lower extremity [Chart 3.]. 

5.Free flaps significantly exceeded the role of local perforator flaps for the distal leg and foot&ankle [Chart 3.].

 

Conclusions:

1.Free flaps have not been eliminated by local perforator flaps, especially for the more distal lower extremity [Charts 2,3.].

2.Both muscle AND perforator flaps have a valid role in lower extremity soft tissue coverage [Chart 1.].