Freestyle pedicled perforator flaps for the reconstruction of lower extremity defects

Background: Lower limb soft tissue defects present unique challenges due to the region's anatomical and functional characteristics. Freestyle pedicled perforator flaps (FPPFs) represent a local skin flap that utilizes adjacent identified perforators, regardless of their source vessel, to cover soft tissue defects. This study evaluated the outcomes of using freestyle perforator flaps to reconstruct lower limb soft tissue defects.Subjects and methods: A prospective study was conducted on 41 patients with 41 lower limb soft tissue defects treated using FPPFs at the Hue University of Medicine and Pharmacy Hospital from March 2022 to September 2024. Data collected included defect characteristics, surgical techniques, and postoperative outcomes. Flap designs included peninsular, advancement/Keystone, and propeller flaps, selected based on defect location and size. Outcomes were evaluated during hospitalization and long-term follow-up.Results: The mean defect size was 27.3 ± 13.2 cm², with infection being the most common cause (73.2%). Among the 41 flaps performed, 87.8% achieved complete survival, and 97.6% maintained optimal outcomes at 6 months, including functional mobility and aesthetic satisfaction. Complications occurred in 12.2% of cases, primarily marginal or distal flap necrosis, but none resulted in total flap loss. Donor site closure was achieved with direct suturing in 90.2% of cases, while skin grafting was needed in 9.8%.Conclusion: FPPFs are reliable for lower limb defect reconstruction with their flexibility and donor site preservation. The modified techniques demonstrated high survival rates, aesthetic compatibility, and improved postoperative quality of life. Further research is needed to minimize venous congestion risks and optimize outcomes.