Pedicle Mini Flap Prevents Distally Based Flap Circulation Disturbance by Reducing Venous Congestion of the Flap: A Retrospective Comparative Study

Background The treatment of soft tissue defects remains a significant clinical challenge, particularly in the lower extremity. Distally based flaps are commonly used to address these defects; however, blood circulation disturbances often compromise their effectiveness. This study explores the clinical benefits of the pedicle mini flap in preventing such circulation issues, offering a potential solution to enhance flap viability and improve patient outcomes. Methods A retrospective analysis was conducted on 78 patients who underwent distally based flaps repair for skin and soft tissue defects with exposed critical structures in the lower limbs at our institution between October 2014 and June 2023. Patients were divided into two groups: the traditional distally based flap group and the pedicle mini group, based on the presence of a pedicle mini flap design. Flaps survival and appearance were assessed during follow-up. Results In the distally based flap group, 1 patient experienced a postoperative arterial crisis, which improved after surgical exploration. 10 patients had venous crises, with six developing partial necrosis, which healed after secondary skin grafting. 2 patients experienced complete flap necrosis, which was resolved with subsequent surgery. The remaining 29 patients had satisfactory flap survival. In the pedicle mini flap group, 32 patients had excellent flap circulation with complete survival. 6 patients developed venous crises, with 4 experiencing partial flap necrosis, but no arterial crises or complete flap necrosis occurred. Conclusion Adding a mini-flap at the pedicle of distally based flaps was associated with a trend toward lower venous congestion, though the difference was not statistically significant. This simple modification may help preserve pedicle vasculature and reduce external compression, representing a potential adjunctive technique. Evidence level: IV