Perforator based flap coverage from the anterior and lateral compartment of the leg for medium sized traumatic pretibial soft tissue defects-a simple solution for a complex problem

Compound fractures involving the leg, exposing the tibia or other poorly vascularised tissues such as tendons still pose a big problem for a reconstructive surgeon and they need early plastic surgical intervention. A prospective study of 10 cases of moderate sized defects in the leg exposing the tibia due to trauma was undertaken between January 2003 and August 2004 with an average follow up of 12 months. Pre-operative identification of the perforator around the wound was meticulously performed using hand held Doppler equipment. Most of the wounds were covered within the first 3-5 days of the injury. All the flaps were raised from the anterior or the lateral compartment of the leg to cover the adjacent tibial bone. Five flaps were raised as proximally based and five flaps were raised as distally based flaps. No flap was raised and advanced in a V-Y fashion. Split skin grafting was required in all cases to cover the secondary raw area created following the flap elevation. All flaps survived and served the purpose. In one case we encountered a deep seated infection resulting in sinus formation needing further debridement in the form of sequestrectomy. In conclusion, the authors believe that the perforator based flap cover described here is simple, safe and a versatile procedure for a trauma surgeon to cover the moderate sized traumatic pre-tibial wounds exposing the bone and the tendons.