Reconstruction with local and free flaps
Local rotation flaps were harvested based on preoperatively identified perforator using handheld Doppler or angiography. We used superselective angiography (SSA) for detection of specific peroneal perforator (Fig. 1). The pedicled hatchet shaped flaps were harvested based on posterior tibial artery perforasomes zone, as described by Abraham et al (Fig. 2)10. Cross-leg reverse sural flap was performed as described in our previous study11. Anastomosis of free medial sural artery perforator (MSAP) (Fig. 3), superficial circumflex iliac artery perforator (SCIP) (Fig. 4) and anterolateral thigh (ALT) flaps were performed in the end-to-side fashion; the cross-leg free latissimus dorsi (LD) and anterolateral thigh-tensor fascia lata (ALT-TFL) flaps (Fig. 5) were anastomosed to the posterior tibial vascular system in a flow-through fashion. All patients scheduled for free flap reconstruction underwent preoperative computed tomography (CT) or magnetic resonance angiography to identify the recipient vessels and the vascular pedicle. Peroperative Indocyanine Green Angiography (ICGA) was performed in cases with suspect free or local flap circulation. In patients who underwent local or free flap repair, short leg splint was applied for postoperative seven days. In patients who received cross-leg flaps, postoperative stabilization was achieved by external fixator or cast splints. Pedicles were cut on day ten after the first session. All patients were followed up at 1st and 6th postoperative months.