Comparision Between Distally-based Peroneal Artery Perforator-plus And Posterior Tibial Artery Perforator-plus Fasciocutaneous Flap For Reconstruction Of The Distal Lower Leg,Ankle And Foot

Objective:This study is to compare flap-viability-related complications, coverage reach, reconstruction outcomes and donor-mobidities between distally-based peroneal artery perforator-plus fasciocutaneous (DPAPF) flap and distally-based posterior tibial artery perforator-plus fasciocutaneous (DPTAPF) flap for reconstruction of soft-tissue defects over the distal lower leg, ankle and foot, and thus provide evidence for selection of the flaps.Methods:Between April of2002and February of2012,270patients underwent the reconstructions with DPAPF flaps (peroneal group, n=216) or DPTAPF flaps (posterior tibial group, n=59). Harvesting both flaps began with exploring the perforators around the pivot point. We subdivided the distal lower leg, ankle and foot into12subregions. In all the patients, flap-viability-related complications and its potential risk factors (including age, sex, etiology, location of top edge, location of pivot point, length and width of both the skin island and adipofascial pedicle, length-width ratio, and total length), coverage reach(the subregion in which the most distal part of the reconstructed defect lies), duration of flap elevation and hospital stay were compared between the two groups. In patients with at least3months postoperative follow-up, comparative study of reconstruction outcomes, patient’s satisfaction with flap appearance and donor-site morbidities were performed between the groups.Results:Partial necrosis rate was lower in the peroneal group (12.0percent versus20.3percent, p=0.101). Marginal necrosis and overall complication (including partial and marginal necrosis) rates in the peroneal group (1.9percent and13.9percent) were significantly lower than those in the posterior tibial group (8.5percent and28.8percent)(p<0.05). Incidence of partial necrosis of the flaps for the defects over subregions7to10in the peroneal group(7of41) was significantly lower than that in the posterior tibial group (2of2)(p<0.05). Constitute ratios of the flaps with top-edge locating in the ninth zone, the flaps with length-width ratio≥5:1and the flaps with skin-island width≥8cm were significantly higher in the peroneal group (p<0.05). Reconstruction outcomes and patient’s satisfaction with flap appearance were comparable in both groups(p>0.05). Incidences of hypertrophic scar, itching and pigmentation at the donor site were significantly lower in the peroneal group (p<0.05).Conclusions:Distally-based peroneal artery perforator-plus fasciocutaneous flap is superior to distally-based posterior tibial artery perforator-plus fasciocutaneous flap in reliability, safe coverage reach and less donor-site morbidities. The former is recommended. as the first choice when either of the flaps is considered to reconstruct soft-tissue defects over the distal lower leg, ankle and foot.