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Bipedicled Flaps for Lower Extremity Distal Third Defects
Neel Bhagat BS, Jessica Berns BS, Steven Dawson BS, Anthony Archual MD, Brian M Christie MD, Erin L Weber MD, PhD, Aladdin H. Hassanein MD, MMSc
Indiana University School of Medicine
2022-01-15
Presenter: Neel D Bhagat
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. All work on this project represents the original work of the residents or medical students involved.
Director Name: William Wooden
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Lower extremity reconstruction of the distal third of the leg is challenging. Although free tissue transfer is the gold standard, alternative local flaps may be useful in select patients. Bipedicled flaps are random flaps with a dual source of dermal flow. The purpose of this study is to assess outcomes of patients undergoing bipedicled flaps for lower extremity reconstruction.
Methods
A retrospective review of patients undergoing lower extremity reconstruction in 2020-2021 was performed. Inclusion criteria were patients aged >18 years with lower extremity wounds secondary to traumatic injury for which bipedicled flaps were utilized in the reconstruction. Exclusion criteria included lower extremity wounds secondary to vascular insufficiency or diabetes.
Results
All patients (n=14) had injury to the distal third of the leg with concurrent tibia (7, 50%), fibula (6, 42.9%), ankle (5, 35.7%), and metatarsal (2, 14.3%) fractures. Eight patients (57.1%) had additional flaps placed at time of bipedicle flap placement. Flaps used in addition to bipedicled flaps included soleus (3, 21.4%), anterior tibialis muscle (2, 14.3%), medial plantar artery (2, 14.3%), posterior tibial artery perforator (2, 14.3%) and abductor hallucis muscle (1, 7.1%). Two patients had partial flap necrosis (14.3%) but healed their defect, and one patient had nonunion (7.1%). Limb salvage rate was 100% (no amputations).
Conclusions
Bipedicled flaps provide an additional wound coverage option in distal limb locations. Bipedicle flaps are more reliable than unipedicled random flaps in the lower extremity and can be used in combination with other local flaps to decrease tension on closure.
