A study on clinical application of adipofascial flaps for reconstruction in leg defects

Background and aims: The reconstruction of lower limb defects is challenging, and several options have been applied for soft tissue covers over the years. We evaluate the indications, limitations, advantages and disadvantages of adipofascial flaps in soft tissue reconstruction of leg defects. The paper aims to study the indications, limitations, advantages and disadvantages of adipofascial flaps in reconstructing leg defects. Methods: Patients with various soft tissue defects of the leg below the knee were studied retrospectively in 25 patients for 1 year 8 months. Planning for the proposed flap was done depending on the availability of local tissue around the defect. Perforators were located by handheld Doppler for perforated based adipofascial flap. Where a definite perforator was not found, and for small size defects, random pattern adipofascial flaps were planned. The surgery was completed in one surgical time with immediate skin grafting. In all cases, split skin grafting over the flap was used, and the donor sites closed primarily. Flap complications, functional and aesthetic outcomes and their satisfaction with the surgery were assessed. Results: There was partial loss of flap in 5 patients. Marginal skin necrosis occurred in 4 patients. Only 2 cases of partial donor skin necrosis required further split skin grafting. The flaps have shown good contour and good donor site scar even in patients with complications. The majority of the cases showed fair to good results on follow up. Conclusions: Adipofascial flaps are helpful in the armamentarium of reconstructive surgery, particularly in small to medium-sized lower leg defects and provides aesthetically better recipient-site scar with minimal donor-site morbidity and favourable functional outcome.

Keywords: Adipofascial flap, lower leg defect, soft-tissue defect, reconstruction.