الفهرس 
ACKNOWLEDGEMENT
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Abstract
Soft tissue reconstruction at leg, especially the lower third, still presents challenges to modern day medicine. The aim of the present study was to assess the efficacy of perforator flaps (either free flaps or pedicled flaps) for coverage of traumatic soft tissue defects of the leg and foot. This prospective study was conducted upon 40 patients with traumatic soft tissue defects in the leg and foot with or without bone injury. The selection of the type of flap depended on the site and size of the defect, the state of surrounding perforators, the availability and condition of nearby tissues. Patients were divided into two groups. group I, included 20 patients who were managed by free perforator flap, among them 14 patients were treated with Anterolateral thigh flap (ALT) and 6 patients were treated by Medial Sural artery perforator flap (MSAP). In group II, included 20 patients managed by pedicled perforator flap, 10 flaps were designed as propeller flaps while the other 10 flaps were designed as perforator plus flaps. In propeller flaps complete freeing of the edges of the flap was done with rotation of the flap around the perforator from 90 to 180 degrees, the other 10 flaps were designed as perforator plus flaps where the base of the flap was not incised and kept in place. A negative suction drain was inserted under all the flaps (both free and pedicled). The donor site was either covered with a split thickness skin graft harvested from the thigh or closed primarily according to the size of the defect. Clinical monitoring of the flap to detect intrinsic vascular problems as well as extrinsic causes of perfusion compromise was essential for the patient’s successful outcome.
The present study confirms that ALT flap is considered the first choice especially for moderate or major sized wounds, while smaller wounds are treated by pedicled perforator flaps. The MSAP is a thin pliable perforator flap with long pedicle up to 11 cm, so it is an excellent option for coverage of the defects on dorsum of foot and over ankle joint. In pedicled perforator flaps, there was a shorter operating time and a shorter hospital stay compared with free flaps. Our study demonstrated that flap salvage is independent of the number of venous anastomoses, as the results are the same in case of one or two veins anastomosis, and the great saphenous vein is a good option for single vein anastomosis. Moreover, our study demonstrated that free flap survival is not depending on length of flap. Our results exhibited no difference in free perforator flap survival (whatever the length of the flap) regarding elevating the flap based on one or two perforators. Regarding pedicled perforator flap, our study documented that the use of perforator plus flap in case of the flap length exceeds one third of the leg length is good option. The only disadvantage of perforator plus flap was its need for another session for debulking the dog ear resulted after peninsular movement of the flap.