Grafts and Flaps for the Lower Limb



The major defects of lower limb of different magnitude are frequently encountered, and majority of them require reconstruction. Such wounds fall into two categories, acute deep wounds and those which have not healed within 6 weeks, i.e., chronic wounds. The common causes are trauma, infection, postexcisional defect, venous ulcer, trophic ulcer, etc. For the consideration of resurfacing, they are divided into those requiring split skin grafts (SSG) and the others which need a flap. Before coverage, an acute wound needs to be free of devitalized tissue and foreign bodies through adequate surgical debridement and cleaning with normal saline under proper light in the operation theater. Similarly a chronic defect should be free of infection which can be achieved by debridement and regular dressing. The wound swab is sent for culture and sensitivity, and accordingly a suitable antibiotic is administered. The defect is then assessed in terms of size, contour, and exposed vital structures. It is also necessary to evaluate whether the defect needs only SSG, flap, or combination of them. Accordingly the decision is made regarding the type of reconstruction. The aim is to have functional and aesthetic outcome preferably in a single stage with minimal donor site morbidity. If it is noncontoured surface defect, split skin graft is indicated. If the underlying vital structures are exposed, e.g., bone and joints, tendons, neurovascular bundle, exposed hardware following bony fixation, etc., a flap cover is needed. Sometimes part of the wound requires a flap and the rest can be managed by SSG (Fig. 1).


Muscle Flap Deep Fascia Fasciocutaneous Flap Peroneal Artery Split Skin Graft 
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  1. 1.
    McCarthy JG. Plastic surgery, General principles, vol. 1. Philadelphia: WB Saunders Company; 1990.Google Scholar
  2. 2.
    Bhattacharya V, Arora R. Fasciocutaneous flap with adipofascial extension in contour defects of leg. Ind J Plast Surg. 2002;35:70.Google Scholar
  3. 3.
    Ponten BC. The fasciocutaneous flap: it’s use in soft tissue defects of the lower leg. Br J Plast Surg. 1981;34:215–20.CrossRefPubMedGoogle Scholar
  4. 4.
    Carriquiry C, Costa A, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg. 1985;76:354–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Tolhurst DE, Haeseker B, Zeeman RJ. The development of fasciocutaneous flap and its clinical applications. Plast Reconstr Surg. 1983;71:597.CrossRefPubMedGoogle Scholar
  6. 6.
    Haertsch PA. The blood supply to the skin of the leg. A post-mortem investigation. Br J Plast Surg. 1981;34:470–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Bhattacharya V, Goyal S, Jain P. Angiographic evaluation of fasciocutaneous flaps. Int Surg. 2006;91:326–31.PubMedGoogle Scholar
  8. 8.
    Bhattacharya V, Watts RK, Reddy GR. Live demonstration of microcirculation in deep fascia and its implication. Plast Reconstr Surg. 2005;115(2):458–63.CrossRefPubMedGoogle Scholar
  9. 9.
    Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40:113–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Bhattacharya V, Deshpande SB, Watts RK, et al. Measurement of perfusion pressure of perforators and its correlation with their internal diameter. Br J Plast Surg. 2005;58:759–64.CrossRefPubMedGoogle Scholar
  11. 11.
    Cormack GG, Lamberty BGH. The fasciocutaneous system of vessels. The arterial anatomy of skin flap. Edinburgh: Churchill Livingstone; 1986.Google Scholar
  12. 12.
    Bhattacharya V, Watts RK. Ipsilateral fasciocutaneous flaps for leg and foot defects. Ind J Plast Surg. 2003;36:30–5.Google Scholar
  13. 13.
    Bhattacharya V, Sunish G, Adil BS. Reconstructive implications of adipofascial flaps in limb defects. Eur J Plast Surg. 2007;30:169–75.CrossRefGoogle Scholar
  14. 14.
    Lee S, Estella CM, Burd A. The lateral distally based adipofascial flap of the lower limb. Br J Plast Surg. 2001;54:303–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Bhattacharya V, Reddy GR, Goyal S, Kumar U. Skeletonised retrograde distal perforator island fasciocutaneous flaps for leg and foot defects. J Plast Reconstr Aesthet Surg. 2007;60:892–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Bullocks JM, Hickey RM, Basu CB, Hollier LH, Kim JY. Single-stage reconstruction of Achilles tendon injuries and distal lower extremity soft tissue defects with the reverse sural fasciocutaneous flap. J Plast Reconst Aesth Surg. 2008;61:566–72.CrossRefGoogle Scholar
  17. 17.
    Vergara-Amador E. Distally-based superficial sural neurocutaneous flap for reconstruction of the ankle and foot in children. J Plast Reconstr Aesth Surg. 2009;62:1087–93.CrossRefGoogle Scholar
  18. 18.
    Lees V, Townsend PLG. Use of pedicled fascial flap based on septocutaneous perforators of the posterior tibial artery for repair of distal lower limb defects. Br J Plast Surg. 1992;45:141.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Department of Plastic SurgeryInstitute of Medical Sciences, Banaras Hindu UniversityVaranasiIndia
  2. 2.FellowGEM HospitalCoimbatoreIndia

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