Two Decades As Witness To The "Rise" Of Local Perforator Flaps, And The "Demise" Of Free Flaps For Lower Extremity Reconstruction?
Geoffrey G. Hallock, MD.
Sacred Heart Hospital, Allentown, PA, USA.
Purpose: Since the advent of local perforator flap options around the turn of the millennium, the literature has emphasized they will soon replace microsurgical tissue transfers. A review of this experience's past two decades is intended to verify this assumption. Methods: All methods for soft tissue coverage of the lower extremity from 2002-present in this private practice have been tabulated for comparison in a prospective charting system. This included all local muscle or fasciocutaneous/perforator flaps and all free flaps. Each group was broken down into 5-year intervals to uncover trends [Graphic—1.]. Results: Over the past 2 decades, 418(58.2%) free flaps, and 221(30.8%) fasciocutaneous/perforator and 79(11.0%) muscle local flaps had been selected for coverage in all zones of the lower extremity. By the 4th 5-year interval, the use of local fasciocutaneous/perforator flaps exceeded that of free flaps almost 2:1, with muscle flaps rarely utilized [Graphic—2.]. Conclusion: Local function preserving fasciocutaneous/perforator flaps have assumed a strong armamentarium allowing a genuine substitute for many defects rather than free flaps in all lower extremity zones [Graphics—2.], but the "demise" of the latter has been greatly exaggerated. Conversely, the traditional role of the muscle flap appears to have become virtually non-existent. 
Back to 2022 Posters