Publication:

Functional outcomes of a perforator-based bipedicled flap for reconstruction of post-traumatic anteromedial leg defects: a prospective study of 76 patients

Background Reconstruction of post-traumatic soft tissue defects over the anteromedial leg is challenging owing to the subcutaneous position of tibia, sparse local muscle coverage, tenuous skin vascularity. Conventional options: local fasciocutaneous flaps and microsurgical free tissue transfer are effective, but associated with technical complexity, donor site morbidity and significant resource requirements. This study prospectively evaluates the outcomes of perforator-based-bipedicled-flap technique as a reliable primary reconstructive option.

Methods A prospective-observational-study was conducted at a single tertiary-care centre between January 2023 and January 2026. 76 patients with open tibial fractures (Gustilo-Anderson types IIIA/IIIB) and associated anteromedial soft tissue defects underwent perforator-based-bipedicled-flap-reconstruction. Posterior tibial artery perforators were directly visualised and preserved during flap elevation. Primary outcome-complete flap survival; secondary outcomes included complication rates, donor site morbidity, functional status at 12 months follow-up.

Results The cohort comprised 70 males (92.1%) and 6 females (7.9%), predominantly in 30-50-year age group. Defects were frequently located in middle-third of the leg (56.6%). Mean defect dimensions were 3×4 cm. Complete flap survival was achieved in 73 cases (96.1%). Complications occurred in 3 patients (3.9%): 2 cases of wound edge necrosis managed with secondary skin-grafting, 1case of progressive limb ischaemia necessitating above-knee-amputation. No functional deficit attributable to the reconstruction was documented at final follow-up. Donor site morbidity was minimal.

Conclusions The perforator-based bipedicled flap provides a technically straightforward, reproducible, cost-effective reconstructive solution for anteromedial leg defects following high-energy tibial fractures. Its favourable survival rate, low complication, inherent intraoperative convertibility makes it a valuable primary option, particularly in resource-constrained settings.