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

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