Perforator-Plus Skin Rotation Flap: Another Alternative Option for Soft Tissue Coverage of a Lower Extremity Wound

Objective: The perforator-plus skin rotation flap is becoming a more viable option for lower extremity soft tissue reconstruction. The concept of the perforator-plus skin flap has become well established as studies have better... [ view full abstract ]

Objective: The perforator-plus skin rotation flap is becoming a more viable option for lower extremity soft tissue reconstruction. The concept of the perforator-plus skin flap has become well established as studies have better characterized the vascular architecture of the skin. Concurrently, our ability to detect cutaneous perforators have improved with use of hand-held Doppler and other pre-op imaging techniques.

Methods: Three consecutive perforator-plus skin rotation flaps were performed by a single surgeon for soft tissue coverage of the lower extremity. Two were used for coverage of orthopedic hardware after exposure subsequent to wound dehiscence; one was used for reconstruction of soft tissue defect after motor vehicle vs. pedestrian injury. A hand-held Doppler was used in all cases to identify the target perforator. Skin grafts were used for the donor site.

Results: All three perforator-plus flaps achieved resulted in successful coverage of the target defect. No partial flap necrosis was seen post-operatively; one case of partial wound dehiscence that was successfully treated with re-advancement of the flap. No local harvest site complications after skin grafting. Average operating time was 180 minutes.

Conclusions: The perforator-plus skin rotation flap is a versatile flap that reduces donor site morbidity, is technically simple to perform and faster than traditional free flaps, and achieves durable coverage long-term. It is a viable alternative option for soft tissue coverage of the lower extremities.