Experience with Perforator Based Flaps for Wound Cover of the Leg and Foot at Nakuru and Eldoret in Kenya.

Background: Open fractures of the distal third of the tibia and fibular offer a challenge to the orthopedic surgeon because of skin coverage. The reconstructive surgeon’s help is often required in trying to achieve this. There are several options: - local flap, free flap or a cross leg flap. Local flaps have always had limitations because of the doctrine of length breath ratio. Perforator vessels have widened the scope for local flaps.The main objective of this study was to study to evaluate ipsilateral perforator-based fasciocutaneous flaps as a modality for covering leg and foot defects.
Method: A prospective study was conducted from June 2009 to July 2010. A total of twelve procedures on eleven (11) patients who presented with Grade III open fractures of the distal third of the tibia/fibula had their wounds debrided. Three days later a perforator based flap was used to cover the exposed bone. The perforators were identified using a hand held Doppler machine. The secondary defect was skin grafted with a split thickness skin graft.
Results: There were 7 males and 4 females with their ages ranging from 4 to 56 years. All the flaps settled well except for two. One flap had minimal marginal necrosis which granulated well and healed with dressing changes, while another flap suffered total necrosis.
Conclusions: Perforator based flaps are a useful and cheap option in management of Grade IIIB fractures especially in the distal third of the tibia.