Soft Tissue Defects of Lower One Third of Leg: Options for Flap Coverage

Background: Lower one third of the leg is more prone to trauma and more susceptible to develop exposed bone that necessitate coverage with flap, the decision to choose flap is difficult and depends on different factors, we tried to compare 3 sets of flaps used for coverage. Patient and Methods: 33 patients were divided into 3 groups according to the type of flap coverage, most of our patient were males and mean age was adult age group. 3 methods for coverage; group I free LD flap used, group II crossed leg flap used, and group III coverage done with perforator flaps. Results: Most of the patient had rood traffic accident as a cause of injury, most common defect in this study was at the lower third leg, the LD flap group has the largest flap size but it has long hospital stay and longer operative time, also all cases require 2ry procedure, highly trained plastic surgical team, the other 2 group had shorter operative time, in group II, 2ry pedicle separation for all cases, easy and versatile flap, difficulties for position fixation for 3 weeks, in last group III had shorter operative time, shorter hospital stay, single operative procedure but has limitation due to smaller flap size and cannot be done if degloving injury occurred. Conclusion: Flap coverage for lower one third leg defect is difficult question to answer, a lot of flaps could be used each method has its pros and cons, perforator flap is easy and versatile with learning curve it can be used for small to moderate size defects, cross leg flap remain as easy and versatile flap and can be used as backup plan for other methods, free LD flap provide large flap size used for large defects.