Fasciocutaneous flaps in the lower limb soft tissue reconstruction – A surgical case series 

SLR - March 2023 - Alexander Trottier, DPM 

Title: Fasciocutaneous flaps in the lower limb soft tissue reconstruction – A surgical case series 

Reference: Martinov M, Argirova M. Fasciocutaneous flaps in the lower limb soft tissue reconstruction – A surgical case series. J Orthoplastic Surg. 2022 May 21; 9, 1-8. 

Level of Evidence: Level 4 retrospective case series 

Reviewed By: Alexander Trottier, DPM 

Residency Program: Kent Hospital, Warwick, RI 

Podiatric Relevance: Whether through traumatic, vascular, or metabolic pathways, many patients present with skin defects to the foot and/or ankle that can lead to long-standing consequences if not managed properly. Patients present with acute traumatic injuries and associated skin defects to Emergency Departments, but not every hospital has surgeons trained to manage these injuries. Muscle flaps and free tissue transfers require extensive training and may need to be harvested from sites of the body that are out of the scope of podiatrists. Fasciocutaneous flaps have provided an alternative option for harvesting flaps to cover skin defects near the site of injury with low donor site morbidity, making them a viable option for foot and ankle defects. These flaps do not typically require special equipment, and the podiatric surgeon could learn how to harvest them with enough training to make it a viable option in any hospital setting. 

Methods: Retrospective surgical case series that evaluated 19 patients with lower limb soft tissue defects from 2019- 2021. A total of 20 fasciocutaneous flaps were performed: 6 Keystone, 6 Reverse Sural, 4 Perforator Propeller, 2 V-Y, and 2 Axial Rotation flaps. Functional scores and aesthetic evaluations were performed via the LEFS and POSAS 2.0, respectively. 

Results: Average surface area of soft tissue defect in 19 patients were 56.4cm2, 14 of which were traumatic in nature. 10 lower third of leg, 4 Achilles tendon, 2 plantar foot, and 3 distal thigh/lower leg. All flaps survived with no donor site complications. Complications occurred in 3 flaps, including limited necrosis secondary to venous stasis (2 reverse sural and 1 perforator propeller). Average preoperative functional score was 21, and 3 months postoperatively the average score was 53.6. The average POSAS 2.0 score, a scar assessment scale, was 36 points postoperatively. The scale ranges from 12-120 with lower scores correlating to better outcomes. 

Conclusions: The authors conclude that fasciocutaneous flaps are viable for soft tissue defects of the lower extremity compared to muscle flaps and other free tissue transfers when proper preoperative planning and preparation are performed. This includes accurate medical history, vascular studies, and healthy soft tissue defects free from infection, among other things. Fasciocutaneous flaps can treat a variety of lower extremity soft tissue defects in the appropriate patient when a proper vascular workup is performed and circulation is well understood on an individual basis. Patients with high energy trauma, or those in need of limb salvage in the setting of nonhealing wounds could benefit from these flaps and provide better function with decreased chance of infection. With proper training, fasciocutaneous flaps could provide the podiatric surgeon another avenue for treating complicated soft tissue defects.