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Reconstruction of Diabetic Foot Defects With the Proximal Lateral Leg Perforator Flap

Lee, Jiunn-Tat, MD*†; Cheng, Li-Fu, MD*†; Hsu, Honda, MBChB†‡; Wu, Meng-Si, MD*†; Chien, Sou-Hsin, MD†§

doi: 10.1097/SAP.0000000000001745
Reconstructive Surgery
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SDC

Background In patients with diabetic foot ulcers requiring flap reconstruction, the choice of local flaps is limited by the lack of adequate tissue available. Free flaps are often bulky, presenting footwear difficulty due to poor contouring. Here, we present our experience of using the proximal lateral leg perforator flap in the reconstruction of thin diabetic foot ulcers.

Methods This is a retrospective study of 17 patients with diabetic foot ulcers reconstructed with the proximal lateral leg perforator flap during January 2013 and December 2015.

Results Nine patients had varying degrees of peripheral arterial disease. The perforator was located 7 to 14 cm (mean, 9.7 cm) from the fibula head. The pedicle length ranged from 5 to 9 cm (mean, 6.9 cm). The arterial diameter of the pedicle measured 0.8 to 1.9 mm (mean, 1.4 mm). There was 1 total flap failure. One other flap complicated by venous thrombosis was successfully salvaged. All donor sites were closed primarily without morbidities. All the wounds were stable without recurrent ulceration during a mean follow-up time of 12 months.

Conclusion The thin, pliable proximal lateral leg perforator flap is an option for the reconstruction of small to moderate diabetic foot defects especially when it is located over the dorsal foot or the ankle. The flap is simple and quick to harvest without sacrificing a major artery. Although it is limited by the short length and the small diameter of the pedicle, for experienced microsurgeons, the success rate is high.

From the *Division of Plastic Surgery, Hualien Tzu Chi Hospital;

School of Medicine, Tzu Chi University, Hualien City;

Division of Plastic Surgery, Dalin Tzu Chi Hospital, Dalin Township, Chiayi County; and

§Division of Plastic Surgery, Taichung Tzu Chi Hospital, Taichung City, Taiwan.

Received August 3, 2018, and accepted for publication, after revision October 6, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Honda Hsu, MBChB, 2 Ming Sheng Road, Dalin 622, Taiwan. E-mail: hondahsu@yahoo.com.tw.

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