Posterior Tibial Artery Perforator Flap for Reconstruction of Soft Tissue Defects in the Middle and Lower Thirds of Leg and Ankle Region: A Prospective Observational Study

Background: Reconstruction of lower leg and ankle defect with exposed bone or tendon is very difficult and challenging task due to scarcity of donor areas. The posterior tibial artery perforator flap has been describedas a good option for small to moderate lower extremity defects with consistent anatomy and calibre. Different designs are found in the literature for posterior tibial artery perforator flaps and are mostly executed as propeller, transposition, and island flaps. Method: The study was a prospective observational study. It was conducted in the Department of Burn and Plastic Surgery, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2021 to June 2022. Sample size was 12. Sampling was carried out purposively. Postoperative follow up period was up to 3 months. Regarding the cause of the defect, 8 cases were traumatic wound from Road traffic Accident, 1 was post infective, 1 was post electric burn wound and 1 from bomb blast injury. Defect size was 4 cm×3cm to 18cm×9cm. Maximum dimension of the flap was 16cm×6cm and minimum size was 6cm×4cm. Posterior tibial artery perforator location was 5cm to 20cm from lowest level of medial malleolous. Rotation of the flap was 30°-180°. In all cases donor site was covered with split thickness skin graft. Operation time was 120 minutes to 180 minutes; mean operative time was 143.3±2.38 minutes. After operation hospital stay was 10 days to 21 days, mean 11.44±3.64 days. Over 1 year, twelve cases were reconstructed successfully with posterior tibial artery perforator flaps with propeller, transposition, island design. Clinical evaluation was done for all patients as well as follow-up in the outpatient clinic until complete healing of the wounds was achieved. Multiple modifications were done intraoperatively to enhance flap reach and minimize the complications, including designing, careful perforator dissection, and finally, strict postoperative course. Results: All cases healed completely but there were some ......