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Cohen-Shohet et al. Plast Aesthet Res 2019;5:28 Plastic and
DOI: 10.20517/2347-9264.2019.030 Aesthetic Research

Review Open Access

Evolution of local perforator flaps in lower extremity
reconstruction

Rachel Cohen-Shohet, Mariel McLaughlin, David Kerekes, Harvey Chim

Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL 32608, USA.
Correspondence to: Dr. Harvey Chim, Plastic and Reconstructive Surgery, University of Florida, P.O. Box 100138, Gainesville, FL
32608, USA. E-mail: harveychim@yahoo.com

How to cite this article: Cohen-Shohet R, McLaughlin M, Kerekes D, Chim H. Evolution of local perforator flaps in lower extremity
reconstruction. Plast Aesthet Res 2019;5:28. http://dx.doi.org/10.20517/2347-9264.2019.030

Received: 15 Sep 2019 First Decision: 4 Nov 2019 Revised: 14 Nov 2019 Accepted: 19 Nov 2019 Published: 9 Dec 2019
Science Editor: Matthew L. Iorio Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract

Lower extremity reconstruction is challenging for a variety of reasons. New techniques for soft tissue coverage
continue to evolve. While free flaps are always an option, free flaps require significant microsurgical expertise, a
proficient staff, advanced equipment, and a patient with a somewhat healthy baseline. However, as microsurgery
has evolved, so has the identification of new anatomy and new techniques - namely, perforator based pedicled
flaps. These flaps have expanded options for lower extremity reconstruction, and continue to advance the field of
microsurgery. The purpose of this article is to review the evolution of perforator based pedicled flaps in the lower
extremity, review the anatomy, and offer examples of design and indications.

Keywords: Perforator flaps, lower extremity reconstruction, soft tissue coverage

INTRODUCTION
Lower extremity coverage has long proved challenging for reconstructive surgeons primarily due to
the paucity of soft tissue and skin available locally. Very often, lower extremity soft tissue injuries are
complicated by associated bone, arterial, or nerve damage. Additionally, the lower extremities have a
functional and mechanical component that further complicates the reconstructive process.

In the pre-microsurgery era, soft tissue reconstructive options were limited to tubularized flaps,
popularized by Gilles, as well as the cross leg flap, originally described in a case report by Hamilton in

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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