In 9 patients requiring inframalleolar bypass (11 extremities), intraoperative consult revealed exposed saphenous vein grafts at either the medial ankle or the dorsum of the foot in which primary wound closure resulted in the reduction or occlusion of blood flow. In these patients, longitudinally oriented bipedicle fasciocutaneous flaps were raised with widths of 3 to 4 cm and lengths ranging from 12 to 18 cm, with Doppler confirmation of discrete fascial perforators. Split-thickness skin grafts were placed in the wake of the flaps. Patient follow-up ranged from 2 to 78 months. All wounds healed, and 10 of 11 limbs were salvaged. Bipedicle flap coverage allows reconstruction of soft-tissue defects with the transposition of local tissues of similar qualities, avoiding the need for more complex distant tissue reconstruction. The inclusion of the deep fascia with the flap enhances its vascular perfusion, even in the ischemic lower extremity, with concurrent revascularization. The reliability of this type of flap is not dependent on traditional concepts of length-to-width ratios, but rather on standard principles of angiosome anatomy.
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