ArticleFrontiers in surgery2026
Application of a posterior tibial artery perforator-based fasciocutaneous flap with a broad fascial pedicle in reconstruction of complex lower-leg wounds: a retrospective clinical study.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Complex soft-tissue defects of the lower leg with exposed bone, tendon, or internal fixation material remain difficult to reconstruct, particularly when the surrounding wound bed has been affected by infection, scar formation, or previous surgery. Free flaps are reliable for extensive defects but require microsurgical expertise and suitable recipient vessels. This study evaluated the clinical outcomes of a posterior tibial artery perforator-based fasciocutaneous flap with a broad fascial pedicle for selected complex lower-leg wounds, while preserving the main posterior tibial artery. Methods: We retrospectively reviewed 15 patients (11 males and 4 females; mean age, 43.5 years; range, 22-65 years) who underwent reconstruction of complex medial or distal lower-leg wounds between January 2019 and January 2024. Etiologies included post-traumatic tissue loss ( Results: All 15 flaps survived completely, with no partial or total necrosis. No hematoma, infection beneath the flap, donor-site functional deficit, or revision surgery occurred. At final follow-up, 8 flaps recovered to S3, 5 to S2, and 2 to S1. Active ankle dorsiflexion and plantarflexion were preserved in all patients, and all patients regained independent ambulation. Donor-site morbidity was minimal, with acceptable linear scarring or healed split-thickness skin grafts. Conclusion: In this single-center retrospective clinical study, a posterior tibial artery perforator-based fasciocutaneous flap with a broad fascial pedicle provided stable coverage for selected complex medial and distal lower-leg wounds. This technique should be interpreted as one application within the established spectrum of posterior tibial artery perforator-based flaps rather than as a distinct new flap type. Because this study was retrospective, uncontrolled, and limited by a small sample size, prospective comparative studies are required to define its relative indications and outcomes compared with other reconstructive options.
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