• Tajsi Nenad, Winkel Reiner, Schlageter Michael, Hoffmann Reinhard, and Husum Hans.
• Institute of Clinical Medicine, Tromsoe University, Tromsø, Norway.
• J Trauma. 2010 May 1; 68 (5): 120012071200-7.

BackgroundThe management strategies for reconstruction of soft-tissue defects of the lower leg and the foot remain disputed. To date, no comprehensive studies have been reported on the saphenous perforator flaps in reconstructive surgery in patients with posttraumatic osteomyelitis.MaterialFifty patients with lower leg postinjury chronic osteomyelitis were included in a retrospective, noncontrolled clinical study conducted from 1995 to 2006. All study patients were managed by distally based saphenous neurofasciocutaneous perforator flaps, the feeding perforators originating from the tibial artery. An endpoint survey was conducted after flap surgery, mean follow-up period 4 years, response rate 60%.ResultsSix patients had short-term flap failure (12%, 95% confidence interval: 5-24). An additional six patients had flap necrosis of <(1/4) that healed without surgical revision. Based on the endpoint data, the long-term success rate was 70% (95% confidence interval: 51-85). Three variables had impact on flap failure rates: the number of previous reconstructive operations, the identity of the performing surgeon, and the area of the primary defect. Other assumed risk factors had no statistically significant impact on short- or long-term results. The anatomic localization of the perforating arteries is described.ConclusionThe saphenous perforator flap is a sturdy flap with low short-term failure rates, also in high-risk patients. The success rate compares well with results of free flap transfers in the management of posttraumatic osteomyelitis. The saphenous flap is a feasible option for posttraumatic reconstructions of osteomyelitis, especially in low-resource settings.

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