Lower-limb Flip-Flap: A simple reliable modification of adipofascial flap for extensive tibial crest cutaneous defect

Introduction: Large cutaneous defects exposing the whole tibial crest are difficult to cover and are conventionally best treated with free flaps. This article describes a technical modification of the adipofascial flap in this indication.

Methods: The "flip-flap" is vascularized by the posterior tibial artery perforators harvested on the medial aspect of the leg. The hypodermal and fascial tissue is de-epidermized and elevated from the posterior midline up to the medial edge of the soleus muscle, then folded over the exposed tibial crest like a page of a book.

Results: A 27×6cm effect was successfully covered on a 72 year-old patient with vascular status precluding free flap. The flap healed by day 21.

Discussion/conclusion: This technical modification is simple and allows coverage of large tibial crest skin defect when a free flap is not possible.