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

Lekhashree G.; Jacob K. Ipe; Sharathgowda K. N.; Saksham Gupta

doi:10.18203/issn.2455-4510.IntJResOrthop20262900

Authors

Lekhashree G. Department of Orthopaedics, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India https://orcid.org/0009-0000-0723-7391
Jacob K. Ipe Department of Orthopaedics, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
Sharathgowda K. N. Department of Orthopaedics, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
Saksham Gupta Department of Orthopaedics, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262900

Keywords:

Bipedicled flap, Anteromedial leg defect, Perforator-based flap, Open tibial fracture, Lower-limb trauma

Abstract

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.

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