Distally based posterior tibial artery perforator flap for coverage
of defects around the ankle, heel and lower third of leg
Md Sohaib Akhtar
M. Fahud Khurram
Received: 18 February 2014 /Accepted: 20 July 2014 /Published online: 14 August 2014
Springer-Verlag Berlin Heidelberg 2014
Introduction Reconstruction of distal leg region remained a
difficult task. Free flaps had long been considered as a gold
standard for these regions. However, due to various limita-
tions of the free flap, a local fasciocutaneous flap could be
considered as a good alternative. In this study, the use of a
distally based posterior tibial artery perforator flap had been
evaluated in the coverage of defects around the ankle, heel,
and lower third of a leg. The study also outlined the donor-site
morbidity and the technical details of the surgical procedure.
Methods In this prospective study, a total of 42 patients with
distal lower leg defects were included. The defects were
located on the lower third of the leg (n=23), ankle (n=11),
and heel (n=8). Reconstruction was performed using distally
pedicled posterior tibial artery perforator flaps. Patients were
evaluated in terms of viability of the flap, functional gain, and
donor-site morbidity. The technical details of the operative
procedure have also been outlined.
Results All the flaps survived well, with the exception of one
patient, who experienced complete flap loss. Minor compli-
cations were, however, noted in four other patients: One
patient developed superficial epidermolysis; one developed
postoperative venous congestion, which subsided within
3 days by conservative means, and in two patients, partial loss
of the skin graft occurred at the donor site but healed
completely with dressing and antibiotics. The patients were
followed up for an average period of 6 months, ranging from 1
to 13 months. Donor-site morbidity was minimal.
Conclusions It was concluded that the distally based pedicled
posterior tibial artery perforator flap was a reliable, easy, less
time-consuming, and versatile procedure for covering the
defects around the ankle, heel, and lower third a leg.
Level of Evidence: Level IV, therapeutic study
Keywords Posterior tibial artery perforator
Distal lower leg
Soft-tissue reconstruction around the heel, ankle, and lower
third leg is a challenging issue for a reconstructive surgeon.
There are many options for covering the distal lower leg, such
as random-pattern flaps, cross-leg flaps , free flap ,
fasciocutaneous flaps , reverse sural fasciocutaneous flaps
, and muscle flaps .
Local random-pattern flap has an indistinct perfusion pat-
tern with limits in size and mobility and has had high inci-
dence of failure . Cross-leg flap has a problem of immobi-
lization; a muscle flap leads to functional deficit; free micro-
vascular transfer needs long operating time; microsurgical
expertise leads to considerable donor-site morbidity .
Currently, perforator flaps represent the most recent and
advanced method of reconstruction as they are safe and reli-
able and have minimal donor-site morbidity.
Perforators from the anterior tibial, posterior tibial, and
peroneal arteries in the lower leg within inter-muscular septa
are reliable .
The study aims at presenting the results obtained from a
consecutive series of pedicled posterior tibial artery perforator
flaps in order to cover soft-tissue defects around the ankle,
heel, and lower third of a leg.
M. Akhtar (*)
M. F. Khurram
Post Graduate Department of Burns, Plastic and Reconstructive
Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
Eur J Plast Surg (2014) 37:547–554