Background: We aimed to introduce our modifications by using eccentrically located
muscular perforators to shorten the distance between the recipient vessels and the
flap pedicle for overcoming the “short pedicle” drawback of the proximal lateral leg
perforator (PLLP) flap.
Patients and methods: A retrospective review of 12 cases undergoing free PLLP flap
for hand and foot regions reconstruction during 2010 and 2019. The mean age was
43.3 years. Most defects resulted from burn and trauma injuries. The dimensions of
defects ranged from 8 x 1.5 c㎡ to 12 x 6.5 c㎡. Muscular perforators were
designed eccentrically 1–3 cm away from the central point of the flap to shorten the
distance between the recipient vessels and the pedicle. The flap was designed to be
0.5–1 cm larger than the defect.
Results: The flap size ranged from 9 x 2 c㎡ to 15 x 6 c㎡. All pedicles were long
enough to ensure an appropriate anastomosis without tension. The post-operative
course in all cases was uneventful. All flaps survived without complications. Primary
repair of the donor sites was performed in all patients. Donor leg function was not
hampered by flap harvesting. All patients were satisfied with the scar after at least
1 year of follow-up.
Conclusion: Based on our experience, selection of the eccentric locations of the
musculo-cutaneous perforators were effective methods to overcome the short pedicle
length of this flap type. Using our modifications, thin PLLP flaps can be used in
foot and hand reconstruction with minimal donor site morbidity and a high
success rate.