Purpose: Inverted pediculated fasciocutaneous flap is an alternative to microanastomosed free flap for cover of tissue loss of the lower third of the leg in trauma victims. We report our experience in fourteen patients.

Material and methods: Fifteen fasciocutaneous inverted pediculated island flaps were performed in fourteen trauma victims with major tissue loss of the lower limbs. Mean age was 42 year (range 24 – 70). There were thirteen men and one woman. The fracture was located on the lower third of the leg and involved the diaphysome-taphyseal junction in thirteen patients (associated with loss of heal tissue on one), the fibular malleolus in one and the tibial column in one. The Gustilo classification was two grade 0, three grade I, eight grade IIIB, and one grade IIIC. Four patients were given first-intention treatment. For the referral patients treated secondarily, three had a dehiscent wound with an exposed fixation plate.

A supramalleolar lateral flap was used in six patients (40%), a sural neurocutaneous flap with a distal pedicle in seven (47%), and a sural neurocutaneous flap with a distal pedicle in two (13%). Seven patients (50%) had a bone graft.

Results: Wound healing was achieved in thirteen patients, with three infectious complications. The one failure involved a sural neurocutaneous flap (grade IIIC fracture). The fixation plate was preserved under the flap in one patient who developed secondary nonunion. Fracture healing was achieved in all cases.

Discussion: Use of island fasciocutaneous flaps with a distal pedicle for the treatment of tissue loss of the lower third of the leg has grown steadily since the introduction of the concept. The principal advantage, beyond the simplicity of the flap procedure, is to spare locoregional vessel and muscle stock. Our series confirmed that this method can give good results if the flaps are carefully planned. This method should not be recommended as an emergency procedure. Combining two fasciocutaneous flaps could be a salvage solution in certain cases where the trauma context implies less concentration in the aesthetic and sensorial result.

Conclusion: Use of fasciocutaneous flaps with a distal pedicle is a first choice solution for covering tissue loss of the lower third of the leg and foot. This method should not be proposed as an emergency procedure.