Kashif Khurshid Qureshi, Khafd Shafique, Muhammad Rafiq Sabir.
Skin coverage of the Lower Leg by Fasciocutaneous Island Flaps.
Pak Armed Forces Med J Jan ;51(2):136-40.

Fourteen cases presenting to our unit with skin loss over the lower 1/3rd of leg including the ankle and heel are presented. The skin loss was the result of roadside accident or was due to diabetic ulcers. Coverage of the wounds was done with fasciocutaneous island flaps based on the perforators of anterior tibial artery, posterior tibial artery peroneal artery and medial plantar artery. These patients would have ended up either in amputation or referral to other specialized units increasing financial cost and mental trauma. There was male predominance (71%) and most of the injuries were the result of roadside accidents (92%). All the wounds except those resulting from diabetes mellitus were labelled as Open Grade IIIB according to the Gustilo classification of open fractures. The wounds were debrided within twelve hours of injury (10 patients). The fractures were stabilized with either external fixator or were internally fixed (one case). Three wounds (21%) were covered with flaps based on the perforators of anterior tibial A., eight wounds (57%) posterior tibial artery perforators and one each on rural A., peroneal A perforators and medial plantar artery. There was superficial necrosis in two patients and deep necrosis occurred in one patient for whom split thickness grafting was done. The results have been encouraging and we are now using fasciocutaneous island flaps for coverage in the area of lower leg, ankle and heel regularly due to the excellent results and easy technique.

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