Distally based Non-Axial Fascial Hinged Flaps: Useful Adjunct to Resurface Traumatic Soft Tissue Defects of the Distal Leg

ABSTRACT

Introduction: Resurfacing soft tissue defects of the posteriordistal leg is a magnanimous surgical task. Numerous surgicaloptions exist but they are aesthetically displeasing. Thishas propelled us to explore the ideal flap and microscopicexamination of deep fascia helped in the evolution of non-axialfascial hinged flap as almost ideal cover. This flap is based ona suprafascial and subfascial plexus. With this objective thestudy was undertaken and surgical experience, planning andsafe dimensions of such flaps were described and discussed.Material and Methods: Thorough flap planning for softtissue defects on the distal leg, dimensions of the defect,preoperative assessment of the donor tissue and surgicalexecution were carried out. Different parts of the flap,dissected and undissected, were mathematically calculatedbased on the anatomical and vascular knowledge and surgicalexperience.Results: The mean age of the 42 patients was 35.02 years(range 18-56 years). Majority were males in the age groupof 21-40 years. The mean size of the flaps was 25.55 cm2,largest flap 10 cm and 6 cm wide. The average hospital staywas 21.09 days and follow up of 4-18 months. Complicationswere occasional and responded to conservative managementand patient counselling.Conclusion: The distally based non-axial fascial hingedflaps is extremely useful for small to moderate size defects ofposterior distal leg defects and gives gratifying results. Thefact that it is thin, stable, durable along with reconstructiondone in one stage adds to the value of the flap