Local Flaps in Lower Leg Defect

Whenever bone, osteo-synthesis material, or tendons are exposed in the lower leg, the reconstructive procedure will be a challenge for the reconstructive surgeon. Because of the lack of available local soft tissue, the middle and distal thirds of the lower leg are the most problematic areas. Local flaps continue to be the gold standard for the coverage of lower leg wounds because of their ability to cover large defects with high success rates and feasibility of using it in acute situations. With the introduction of angiosome concept and the availability of handheld Doppler, the incidence of perforator flaps has increased and the need for microvascular reconstruction has come down. Of the muscle flaps, the peroneus brevis flap can be used in lower leg defects around the malleolar region. In spite of all recent advances in microsurgery, cross-leg flaps still continues to remain as a useful technique and can be used as a backup procedure in an urgent situation. In the author's practice local flaps continue to be the first choice of management for coverage of wounds in the lower leg defect.