OUR EXPERIENCE WITH LOCALLY PEDICLED FLAPS IN THE RECONSTRUCTION OF CRURIS SOFT TISSUE DEFECTS

Abstract

Objective: Soft tissue defects of the cruris present significant reconstructive challenges because of the limited local tissue availability and frequent exposure of bone, tendon, or hardware. This study aimed to present our clinical experience with locally pedicled flaps used in the reconstruction of cruris soft tissue defects and to discuss practical considerations in flap selection and pedicle management.Material and Methods: This retrospective observational study included patients who underwent reconstruction of cruris soft tissue defects with locally pedicled flaps at Ankara Bilkent City Hospital between January 2024 and December 2025. Patients reconstructed with proximally based sural artery (PSA) flaps, reverse sural artery (RSA) flaps, or posterior tibial artery perforator (PTAP)-based adipofascial turnover flaps were included. Demographic characteristics, defect location and etiology, flap type, complications, and secondary procedures were evaluated. Primary outcomes included flap survival and flap-related complications, while secondary outcomes included donor-site morbidity and skin graft take.Results: Seven patients were included in the study, with a mean age of 36.7 years (range, 18-60 years). The most common indication for reconstruction was trauma (n=5), followed by tumor resection (n=1) and osteomyelitis (n=1). Two defects were located in the proximal third of the cruris, one in the middle third, and four in the distal third. Reconstruction was performed using PSA flaps in two patients, RSA flaps in four patients, and PTAP adipofascial turnover flaps in two patients. One RSA flap was augmented with venous supercharging. Complete flap survival was achieved in five patients. Two RSA flap cases without venous supercharging developed marginal distal necrosis, which was successfully managed with debridement and split-thickness skin grafting. No total flap loss occurred.Conclusion: Locally pedicled flaps represent reliable and practical options for the reconstruction of cruris soft tissue defects. When flap selection is guided by defect location and pedicle reach, satisfactory outcomes can be achieved without the need for microsurgical reconstruction. Attention to venous drainageand meticulous postoperative management may further reduce complication rates.