Paucity of protective subcutaneous fat layers, muscles, presence of only tendons, vessels in tight compartments with little collateral circulation make coverage of wounds in lower third of leg and down a challenging problem. Free flap operations are gold standard these days but need high microsurgical skills and operating Loupes or microscope.

Small to medium sized defects can be covered with perforator based flaps from the vicinity of the defect without much difficulty. Preoperative Doppler mapping of perforators is must. Secondary defects covered with split thickness skin grafts.

Keywords: Pre tibial defects, perforator based faciocutaneous flaps, Doppler study.

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Dr Sumit Singhal MS, MCh (Plastic Surg)

Associate Professor, Deptt. of Surgery, Pacific Institute of Medical Sciences, Umarda, Udaipur 313001 Raj.