Reconstruction with local and free flaps
Local rotation flaps were harvested based on preoperatively identified
perforator using handheld Doppler or angiography. We used superselective
angiography (SSA) for detection of specific peroneal perforator (Fig.
1). The pedicled hatchet shaped flaps were harvested based on posterior
tibial artery perforasomes zone, as described by Abraham et al (Fig.
2)10. Cross-leg reverse sural flap was performed as
described in our previous study11. Anastomosis of free
medial sural artery perforator (MSAP) (Fig. 3), superficial circumflex
iliac artery perforator (SCIP) (Fig. 4) and anterolateral thigh (ALT)
flaps were performed in the end-to-side fashion; the cross-leg free
latissimus dorsi (LD) and anterolateral thigh-tensor fascia lata
(ALT-TFL) flaps (Fig. 5) were anastomosed to the posterior tibial
vascular system in a flow-through fashion. All patients scheduled for
free flap reconstruction underwent preoperative computed tomography (CT)
or magnetic resonance angiography to identify the recipient vessels and
the vascular pedicle. Peroperative Indocyanine Green Angiography (ICGA)
was performed in cases with suspect free or local flap circulation. In
patients who underwent local or free flap repair, short leg splint was
applied for postoperative seven days. In patients who received cross-leg
flaps, postoperative stabilization was achieved by external fixator or
cast splints. Pedicles were cut on day ten after the first session. All
patients were followed up at 1st and 6th postoperative months.