What Is Safe Limit of the Perforator Flap in Lower Extremity Reconstruction? Do We Have Answers Yet?

We make an attempt to define the safe extent of local perforator flap for lower limb reconstruction by comparing it with the limb length of the patient. The maximum flap length from the perforator was compared to the limb length in 35 patients using EPI info 6.04？D software. On comparison of flaps that were less than one-third of limb length to those which were more than one-third of limb length, the statistical values were significant. The odds ratio calculated was 6, which means that there is a six times more chance that a local perforator flap will necrose if it is more than one-third of the limb length as compared to a flap which is less than one-third of the limb length. 1. Introduction Lower limb trauma is one of the most commonly encountered problems by the plastic surgeon. Various modalities of options from locoregional to free flaps have been described for lower extremity defect reconstruction [1]. French and Tornetta [1] review the recent literature of lower extremity trauma and options for bone fixation and soft tissue coverage. Fasciocutaneous flaps are difficult to reach in the distal part of the leg. Musculocutaneous flaps lead to loss of function of the particular muscle. Free flaps are considered to be very good options, but the obvious drawbacks are that it needs considerable expertise and generally one of the two major vessels is used for anastomosis. So, there has been considerable stress to find out local flap coverage for these defects, a flap which would be technically easier than the free flaps, which would not lead to loss of function of any muscle or muscle groups, can be used in all parts of the leg, have minimum donor site morbidity, and is reliable. Perforator flaps are the nearest to the above-mentioned criteria. However, there are no studies to define the safe limit of the perforator flap in lower extremity reconstruction. An attempt is made to refine the technical operative details of the perforator flap and to define the safe limit of the perforator flap in lower extremity reconstruction. 2. Material and Methods Thirty-five patients of lower limb defects below the knee were considered in the study. Only those patients where the perforator flap was islanded were included. Perforator plus flaps where the base of the flap was kept intact were not included in the study. The details of the operative procedure are as follows. We did preoperative perforator identification by hand-held Doppler with an 8？Hz probe in all the patients. All the perforators along the surface markings are marked, and the axis of the flap is marked in