The use of local perforator-based flaps for reconstruction of soft tissue defects of the lower extremity is a simple and safe alternative to the more complex and time-consuming microsurgical reconstructions. This has been made possible through better understanding of the cutaneous circulation and local vascular anatomy and innovations in flap design. This review describes the evolution, technique, and modifications of pedicled perforator-based flaps, particularly in the reconstruction of posttraumatic defects of the lower third of the leg. Attention is focused on the perforator-based posterior tibial, adipofascial, and dorsal foot flaps. We also highlight the concept of the ad hoc perforator flap, a flap that decreases dependence on preconceived designs.
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