Purpose:
For reconstruction of four extremities, we need to consider not only wound coverage but also function restoration. There are many vital structure related to motor function, including nerves, bones, muscle and tendons, which are our objective to coverage. We also need to consider the pliability of the post reconstruction limbs. Anterolateral thigh flap, which is the workhouse option nowadays because of its huge area and ease of harvested, usually is too bulky for limbs reconstruction, especially the defect being near the joints. We have 10 years’ experience of proximal lateral leg perforator flap, which provide less donor site comorbidity and excellent flap pliability though with difficult harvesting, and we will presented and discussed about these cases.

Method:
From 2009 to 2019, there are 12 patients receiving PLLP flap 4 limbs reconstruction, retrospectively. The injured mechanism, reconstruction site, defect size, pedicle length, perforator diameter and harvesting times are all recorded.

Result:
Among all 12 patients, 5 received hand, 3 received foot and 4 received leg reconstruction. The mean pedicle length is 5.33cm. The mean flap thickness is 5.2mm. The mean perforator diameter is 2.4mm with the 2.2mm veins. The average harvesting time is 52 minutes. There are only 1 complication of flap failure due to unrecoverable arterial thrombosis, with the success rate of 91.7%.

Conclusion:
The donor site morbidity of PLLP flap is low and the major vessels in leg were not interfered. It can be repaired primarily if the flap width is less than 7 cm. Selection of musculo-cutaneous perforator and eccentric position of the perforator are effective methods to overcome the disadvantage of its relative short pedicle length. The diameter of perforator artery and veins are suitable for microvascular anastomosis. PLLP flap is a thin and pliable flap which can be effectively used in foot and hand reconstruction and avoids recipient site bulkiness.

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