We hereby report a case of avulsion amputation of the hand through the distal carpal row. The severity of the injury was such that it had avulsed the soft tissues from the forearm and the skin from the level of the arm as though a full sleeve of a shirt was being ripped off. Due to the extensive damage in multiple planes, the amputated part could not be saved. The below-elbow amputation stump though was covered with a new local flap based on the interosseous membrane and the periosteal flaps from the radius and ulna. The stump healed well and the patient recovered the full range of elbow movements.

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Context: Scar following facial trauma is an important problem affecting aesthetics and function. Aim: The aim of the study is to compare the usefulness of topical silicone gel versus coconut oil in facial scar modulation. Design: Prospective randomized comparative study was done between January and December 2016. Subjects and Methods: Seventy-four post-traumatic facial scar patients were randomized into three groups − Group A topical silicone gel only, Group B coconut oil only, and Group C both. Observational data were collected and photographs were taken at 2 weeks, 1 month, 3 months, and 6 months. Vancouver scar score and visual analog scale score were done for observational data. Photographs were analyzed by two independent blind observers at the end of the study. Results: Topical silicone gel gave superior results in reducing vascularity and pliability at 1 month and hyperpigmentation at 3 months. Coconut oil has better antipruritic effects at 1 month as compared topical silicone gel. Conclusions: Topical silicone gel is a superior product for initial management of facial scars compared to coconut oil.

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INTRODUCTION: Palm kernel oil, Shea butter and honey are used traditionally for the treatment of variety of ailments in West Africa, but there are no scientific report on burn wound healing activity of Shea butter and palm kernel oil, although honey has been in use for the treatment of burn wound. This study aim to compare the wound healing effect of these organic compounds (palm kernel oil, Shea butter and honey) in the treatment of deep dermal or full thickness burn wound to the conventional Silver sulfadiazine and povidone iodine creams in laboratory albino rats. MATERIALS AND METHODS: 25 rats weighing from 250–300 grams were randomly divided into five groups. About 225 mm² deep dermal burn/or full thickness burn wound was created on the dorsum of the rats. The burn wound were dressed every alternate day with group (1) treated with honey; group (2) Shea butter; group (3) palm kernel oil; group (4) 1% silver sulfadiazine and group (5) 5% povidone iodine cream. Epithelialization observed and contraction was measured at the time of the dressing. FINDINGS: There was rapid reduction in the wound size by day 6 (P≤0.05) in the palm kernel and povidone iodine cream treated group and by day 8 the wound in both group were completely closed, the Shea butter treated group wound shows significant contraction by day 10 and the wound were closed only from day 14 on ward. CONCLUSION: Palm kernel oil is an affordable and readily available topical agent that holds potential for rapid burn wound healing.

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Introduction: A global trend to improve appearance has been observed with the advent of technological civilization and contemporary culture. This is related to social customs that places high premium on appearance, and the increased accessibility of cosmetic surgery. This article explores the perception of cosmetic surgery among university students in Nigeria. Materials and Methods: Self-administered questionnaires were used to collect data. It was divided into four sections; demographic, knowledge, attitude, and experience with cosmetic surgery. The association between knowledge, attitude, practice, and sociodemographic characteristics was sought using Chi-square statistical test. Statistical significance was set at P ≤ 0.05. Results: The respondents perceptions of what cosmetic surgery means include surgery for beauty 673 (52%), surgery on the face 84 (7%), use of chemicals for beautification 35 (3%), correction of deformity 37 (2.8%), and 116 (9%) were not sure. A significant association was found in attitude in the 15-25 age group, when asked about willingness to undergo cosmetic surgery. (P = 0.014) and recommending cosmetic surgery (P = 0.024). There was no statistically significant difference in gender when comparing the knowledge, attitude, and practice of cosmetic surgery. There was a significant difference in knowledge of cosmetic surgery among 3 ^rd and 4 ^th year students related to having heard about cosmetic surgery (P = 0.048) and knowledge of difference between cosmetic surgery and plastic surgery (P = 0.001). Participants that were single were more aware of cosmetic surgery (P = 0.013) and knew someone who had cosmetic surgery (P = 0.000). Conclusion: Attitudes toward cosmetic surgery are positively related to age, level of study, and marital status. However, there was no statistically significant difference based on gender. Our study also suggests that respondents are aware of the existence of cosmetic procedures, but they do not know what it actually means.

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Background: The islanded pedicled perforator-based propeller design flap is a versatile local flap for reconstruction of defects of lower limbs from knee to leg to ankle to foot. Patients and Methods: All patients with small-and moderate-sized defects in lower limbs which required a flap cover are included in the study. Between October 2014 and September 2015, prospective study of patients undergoing perforator-based propeller flap procedure was performed. Patients were evaluated for defect size, defect location, procedure done, and donor site cover. Results and complications of the propeller flap were also analyzed. Atotal of eight flaps were done to cover defects of lower limbs. Results: Out of the eight flaps, seven were islanded on posterior tibial artery, one on the lateral geniculate artery perforator. Four flaps were used to cover lower one-third leg, three for middle one-third leg, and one for knee. The flap dimensions ranged from 3 cm×7 cm to 7 cm×19 cm. The median angle of rotation was 160°(ranging from 60° to 180°). Sixty-three percent of patients had associated fractures. Seven flaps survived completely and one flap had partial necrosis, which was managed with secondary split skin grafting. Conclusion: The islanded propeller design pedicled perforator flaps provides reliable coverage for small-to medium-sized defects for lower limbs, particularly lower one-third leg defects. This flap can provide an esthetically acceptable result as well.

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Retaining a dressing on the phallus has always been difficult. Newer and innovative techniques are coming up in this regard. One such method is suggested which we find extremely useful. Advantages of this dressing are easy application, stability for long time, and easy and painless removal. Our dressing named as "Shukla dressing" is simple, cheap, easily available, and provides comfort to the patient as well as surgeon and caring nursing staff.

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Background: Reconstruction of complex defects following radical tumour excision and post-traumatic defects has been made possible with the use of microsurgical free tissue transfer. It is associated with less donor site morbidity and hence and good surgical outcome in the reconstructed area. It is a routine procedure in the developed countries, however it is gradually evolving in the developing nations. Method: The records of all patients who had free flap reconstruction of their defects were retrieved from the unit database. The demographic characteristics, indications for surgery, choice of flap and the complications were documented. The data were analysed using appropriate statistical tools. Results: Free flaps represent 1.7% of all major flap surgeries performed. Among these patients, those between the ages of 21 and 30 years had highest number of free flaps accounting for 26% of the study population. Anterolateral thigh flap (ALT) was the most common donor flap. Venous compromise was more common among patients who developed complications. Conclusion: Despite many challenges facing successful microvascular surgery in the developing nation, formation of dedicated team and institutional support will improve the outcome of these procedures.

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The Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) instituted a lecture in honor of the doyen of Plastic Surgery in Nigeria, Professor Joseph Olatunde Oluwasanmi. A man who took up the challenge to specialize in plastic surgery thus becoming the first indigenous consultant plastic surgeon in 1967. He rose through the ranks to become a professor in 1973. The 2017 annual conference of the association took place in Sokoto and the lecture focused on the history and practice of plastic surgery in Nigeria. The lecture chronicled those who practice plastic surgery in Nigeria beginning from Mr Michael Norbert Tempest, a British Surgeon who worked in University College Hospital (UCH), Ibadan as a consultant, while Mr J.O. Oluwasanmi (now Prof J.O. Oluwasanmi) worked under him as a Senior Registrar. Oluwasanmi was later appointed as the first indigenous Consultant Plastic Surgeon in1967 after returning from the UK where we went for his specialty training in plastic surgery. Many other centers sprang up providing plastic surgery services. These centers include Lagos University Teaching Hospital, Lagos; National Orthopedic Hospital, Igbobi Lagos; National Orthopedic Hospital, Enugu; Ahmadu Bello University Teaching Hospital, Kaduna; Mangu Rehabilitation Centre, Mangu Plateau State and ECWA Evangel Hospital Jos (now Bingham University Teaching Hospital). Most of these centers have continued to provide plastic surgery services and training while several others have joined the train. Plastic surgery is now well established in Nigeria, however there are still challenges that affect the provision of excellent service. These challenges include; inadequate personnel, lack of awareness of the practice of plastic surgery, limited infrastructure, poverty and lack of universal health coverage, cultural practices and believes, patients’ expectations, complications, complexity of cases and workload.

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Introduction: Ectrodactyly, often the center of attraction due to the mystifying appearance, is a challenging surgical entity as more often the affected children seek cosmetic improvement and also want their feet to fit into normal footwear. Aims and objectives: Not much has been written in the literature of the surgical treatment of this rare entity. This article has been written to address the surgical options and treatment of this rare deformity. Results: We report a case series of five affected children treated in our institute over a period of 4 years. The cases were followed up for a period of 1 year, and there were no recurrence. Conclusion: Surgical descriptions for correction of this rare entity are few and this article aims to address this lacuna, helping in proper correction of this deformity.

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Objective: To present some of the hazards prevalent because of the usage of pentazocine injection and create awareness for the prevention and early detection of its resulting complications to reduce morbidity and mortality in our environment. Design: A retrospective cohort study. Setting: The Ladoke Akintola University of Technology Teaching Hospital, Osogbo and Ogbomoso centers. Patients and Methods: The surgical management of 11 health workers with complications because of pentazocine injection between December 2013 and November 2014. Results: Eleven health workers presented with complications, which needed surgical intervention, because of pentazocine injection. Among the health workers, five were females and six were males, with four medical doctors, three nurses, three attendants, and one medical student. Conclusion: A lack of knowledge regarding the risks because of pentazocine addiction and the easy availability of this drug over the counter have contributed immensely to the insurgence of its surgical complications. Health education should be directed toward prevention, early diagnosis, and management to abolish or reduce morbidity associated with these complications.

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Introduction: Achilles tendon injuries have been on the increase worldwide, especially in the last two decades. The classification of the injury has not been explicit and the management protocols are confusing, especially with respect to specific injuries. There is a need to have a look at the current trends in the management of this common injury in order to create awareness and stimulate the need for standardization of the treatment protocols, possibly reaching a consensus. Materials and Methods: Information on the types of the injury, classification, and treatment modalities were obtained by searching the Pubmed, Medknow, Google Scholar, and other publications. These were collated and analyzed. Results: In most of the information on Achilles tendon injuries, these were inappropriately equated with Achilles tendon ruptures, which are actually supposed to be a subset. In the same vein, the diverse treatment options available were mainly those extensively used in ruptures. These procedures range from open surgery and minimal access surgery to close or conservative management followed closely with physiotherapy. Conclusion: There is a subtle misconception in the literature that we reviewed where Achilles tendon injuries were considered the same as Achilles tendon ruptures but this is not so. There are other injuries with different pathomechanisms and therefore, different managements. There is a need to include these other injuries and also broaden the management options. Minimal access surgery is preferred in ruptures.

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Objective: Tubularized incised plate (TIP) urethroplasty has rapidly become the procedure of choice for repair of distal penile hypospadias (DPH) at most of the centers throughout the world. We did some modifications in the original technique to improve the outcome. In this article, the technique of TIP urethroplasty is discussed and literature is reviewed. Materials and Methods: TIP urethroplasty was performed in 250 new cases of DPH from January 2005 to December 2015 in our institute. We included only primary DPH with typical characteristics including stenotic meatus, deep glandular groove, wide urethral plate distally and in middle, and adequate size penis. We did some modification in the original Snodgrass repair to improve our outcome. Neourethra was covered with vascularized pedicled dartos flap from the inner prepuce. Patients were followed up for a mean of 12 months. Results: Age range of the patients varied between 3 and 11 years with majority of them [235 (94%)] below 9 years; 50 (20%) patients had mild-to-moderate chordee, which was corrected by degloving of the penis. We did not require tunica albuginea plication to correct chordee because it was only skin chordee. The mean age of children was 6 years. Mean duration of surgery was 50 min (45–60 min). Postoperative hospital stay was 10 days. Overall complication rate, requiring specific intervention, was 13.2%. Major complications occurred in 30 (13.2%), urethrocutaneous fistula in 15 (6%), meatal stenosis in five (2%), complete dehiscence in three (1.2%), glanular dehiscence in five (2%), and proximal stricture in five (2%) patients. Functional results as judged by the urinary stream were good in 225 (90%) patients. An excellent cosmetic result was seen in 215 (86%) patients. Conclusion: TIP urethroplasty with dartos flap cover is a simple, single-stage procedure for DPH with excellent cosmetic and functional results and is associated with minimal complications. Finally, some of our modifications in the original technique can improve the outcome.

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Context: Skin cancers are common among albinos living in Africa. Deleterious effect of ultraviolet rays from sunlight and nearness to the equator places the African Albinos at risk for skin cancer. Aims: This study aims to present skin cancers in albinos as seen by a plastic surgeon, sensitize the public to the magnitude of dangers that albinos are exposed to, highlight the challenges faced in their management and suggest strategies for improved outcomes. Settings and Design: A retrospective review of skin cancers among albinos was conducted at the University College Hospital, Ibadan, Nigeria. Methods and Material: The charts, operation and cancer registry records of all albinos referred to a plastic surgery division over a ten year period was reviewed. Demographic data and relevant information relating to skin lesions were extracted. Statistical Analysis: Descriptive analysis was done with the aid of statistical package for social sciences (SPSS) version 20. Results: Nineteen patients with fifty nine skin lesions comprising 13 males and 6 females were reviewed. Mean age of the patients was 33.6 (SD 12.8) years, 50% were unmarried, over 90% were Christians and 44% were not employed. The lesions were on the face in 84.6% while scalp and neck lesions were present in 36.8 and 31.6% of patients respectively. In 73.7% of the patients, the lesions were advanced. Basal cell carcinoma and squamous cell carcinoma were of equal proportion. Conclusions: Albinos in Nigeria should be exposed to public health intervention to reduce the incidence of skin cancers through targeted public health educational programmes; structured multicenter and population based research, surveillance, and improved access to healthcare.

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Objective/Purpose: A pilot study to assess the efficacy of compression therapy on the healing rate of chronic leg ulcers (CLUs) in patients with sickle cell anemia (SCA) in Nigeria. Materials and Methods: A cohort study of patients with SCA and CLU complication was conducted using simple random sampling method to enroll patients from communities in Ibadan, Oyo State, Nigeria. A total of 18 patients with SCA having a total of 25 chronic leg ulcers and ankle brachial pressure index >1 were treated with a high compression bandage of four layers on a weekly basis after wound assessment for a period of 3 months. Wilcoxon signed-rank test was used to compare wound area at pre- and postintervention. Results: The enrolled patients with SCA were in the age range of 19–44 years, and mean ± SD was 28.8 ± 6.5 years. The initial median ulcer size was 38.4 cm² (range 0.5–416 cm²); 21 leg ulcers (84%) were >10 cm² in size at the beginning of the study. These leg ulcers had been present for a median age of 7 years (range 1–22 years). The compression therapy technique achieved >50% healing rate in 16 legs (64%) with an initial ulcer size of 0.5–312 cm². Four leg ulcers (16%) were completely healed during the study. The postintervention median ulcer size was 18.6 cm² in all the 25 leg ulcers studied (P < 0.001). Conclusion: Compression wound therapy promotes a positive healing rate of the CLUs in patients with SCA in Nigeria.

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Background: The burn unit, like any high dependency, unit is awash with multi-antibiotic resistant microbes, and the clinician is in a constant battle to prevent such infections from becoming established. After the elimination of hypovolemic shock as a cause of death, infections constitute the leading cause of morbidity and mortality in burn patients. Aims and Objectives: This study aimed to determine the incidence of infection in our burn unit and to demonstrate how our burn unit routine leads to a low incidence of infection in our setting. Materials and Methods: This is a retrospective review of the records of patients attended to between 2009 and 2013 in the burn unit of Federal Teaching Hospital, Gombe, Nigeria. Details of the treatment and follow-up data were obtained from patients' case files using a predesigned pro forma. All patients were within 24 h of burn and had wounds cleaned under general anesthesia before admission to the unit. In addition, all patients with major burns received infusion of glucose, potassium, and insulin (GKI). Antibiotics use was strictly regulated and was guided by known antimicrobial and sensitivity patterns. Results: Thirty-three patients were admitted within the study period, of whom 27 patients had complete information and were analyzed. The mean age of the burn patients was 11 ± 16.7 (SD) years. There were 16 (59.3%) males and 11 (40.7%) females. Scalding and flame burns accounted for 20 (74.1%) and seven (25.9%) patients, respectively. Only four (14.8%) patients developed wound infection on admission (three were in the age range of 11 years and below, while one was 57 years old) and one patient had gastrointestinal tract (GIT) infection. One patient died from suspected thromboembolism within 24 h of burn, and 14 (51.8%) and 12 (44.4%) patients were discharged with and without residual burn wounds, respectively. The average burn surface area was 18.9%. The average length of stay (LOS) was 18.65 days and the average LOS per patient per percentage burn surface was 0.98 days. On follow-up at 2 weeks after discharge, four (14.8%) patients had delayed wound healing and seven (25.9%) patients developed hypertrophic scars. Conclusion: Our findings indicate a low incidence of infection related complications and it appears that our burn unit routine may play a significant role.

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OBJECTIVE: To evaluate the effectiveness of flap surgery for grades 3 and 4 pressure ulcers. DESIGN AND SETTING: Patients were included in this prospective study conducted in the Department of Burns and Plastic Surgery, Post Graduate Institute of Medical Sciences, Rohtak, along with the institute’s Paraplegia Unit. The outcome of flap surgery was assessed. PARTICIPANTS: The sample size was of 25 spinal cord injury patients with grades 3 and 4 pressure ulcers. INTERVENTION: After wound preparation, flaps were used to cover the resultant defect. OUTCOME MEASURES: The outcome was assessed on the parameters of wound dehiscence, flap necrosis, and recurrence. RESULTS: Points were allotted for the overall outcome assessed over the said parameters, 92% of the patients had excellent outcome and the remaining 8% had a good outcome, proving that flap surgery is extremely effective in management of patients with pressure ulcers. CONCLUSION: Pressure ulcers are a common sequalae of spinal cord injury. Irrespective of the cause, a patient of spinal cord injury would develop a pressure injury at some point of time. Pressure ulcers were best treated with flap surgery, after thorough debridement including dead or necrotic bone, along the special care to positioning.

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This is a case report to highlight the atypical presentation of hand ulcers caused by herpes simplex virus (HSV) in immunocompromised patients. We report a case of a 43-year-old right-handed female who developed a nonhealing and progressive ulcer involving the left middle finger and extending to the palm for which she was referred to our facility. Initial clinical diagnosis following examination was squamous cell carcinoma. However, carefully observed similar new lesions she developed while being investigated was in favour of HSV infection. She had remarkable response on acyclovir which substantiated the diagnosis. Awareness and a high index of clinical suspicion are required of physicians who may come across similar lesions.

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Objective: To document the clinico-pathological characteristics of skin malignancies seen at Benue State University Teaching Hospital, Makurdi. Materials and Methods: A 3-year retrospective study of patients with histologically-confirmed skin cancers presenting to our institution from April 1, 2012 to March 31, 2015 was done. Relevant data was extracted from the patients' records and subjected to statistical analysis. Results: Records were available for 43 patients with a mean age of 46 ± 18 years. There were 21 males and 22 females with a male:female ratio of approximately 1:1. Squamous cell carcinomas were the most common histologic type seen (44.2%) followed by melanoma and Kaposi's sarcoma (25.6% each) while basal cell carcinomas accounted for 4.7%. Farmers (37.2%) and artisans (23.3%) were the most common occupations seen. Human immunodeficiency virus (HIV)-positive patients accounted for 27.9% of the total and albinos 18.6%. Majority of the patients (60.4%) had history of prolonged exposure to sunlight with little regard for protective measures. The average duration of symptoms before presentation was 28 ± 33 months. Conclusion: The study suggested an association between skin cancer and prolonged, unprotected exposure to sunlight on one hand and HIV infection on the other. It highlights the need to promote basic preventive measures.

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Background: Radial forearm free flap is the work horse in head and neck reconstruction. The venous drainage of the flap is by both superficial and deep group of veins. Aim of the Study: To compare the efficacy of venous drainage by single superficial vein (cephalic vein) with dual vein (cephalic vein & venae comitantes) in radial forearm free flaps and its impact on flap survival. Patient and methods- A total of 154 patients undergoing radial forearm free flap for reconstruction following resections of head and neck cancer were studied prospectively . In group 1 (75 cases) only cephalic vein was used as the draining vein and in Group 2 (79 cases) both cephalic vein & one venaecomitantes were used as the draining vein. Patients with non availability of cephalic vein as a result of chemotherapy or injury were excluded from the study. Data were retrieved frompatients' files and analyzed using SPSS computer software version 15.0. Observation and Results: The flap survival rate was 97.33% (73/75) in Group 1 versus 98.73% (78/79) in Group 2. The result is analysed statistically by using SPSS computer software version 15.0. and the P value > 0.50 (c² with Yates' correction=0.00206555, df=1) stastically not significant. Conclusion: Though two vein anastomosis may provide a more fail safe theoretical advantage, single superficial vein (Cephalic) provides effective and adequate drainage with less operative time and no additional morbidity.

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Introduction: This study was done to evaluate the usefulness of V–Y advancement gluteus maximus fasciocutaneous flap in the management of sacral defects. Material and methods: A total of 15 patients with sacral defects either due to sacral pressure sores or defects following excision of sacral soft tissue tumors were treated using this technique in a single stage. The size of the defect and postoperative complications in each patient were assessed. The follow-up period was a minimum of 1 year. Results: All wounds healed with no recurrence. During follow-up, two patients had wound healing problems with wound discharge which healed with dressings within 2 months. Conclusion: The use of V–Y advancement gluteus maximus fasciocutaneous flap offers an easy and safe flap in sacral defect reconstruction.

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Mobile blast injuries are increasing in recent times specifically in India. This increase in incidence in recent times is attributed mostly to the usage of cheap, low-quality phone and battery as well as the use of the mobile phone while charging. We are reporting the case of a 10-year-old boy who had met with a mobile phone blast injury to the right hand while he was playing a mobile game during charging. We will also discuss measures to prevent such injury.

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Cenani–Lenz syndrome is a rare autosomal recessive congenital malformation syndrome characterized by syndactyly and oligodactyly of fingers and toes, disorganization and fusion of metacarpals, metatarsals, and phalanges, radioulnar synostosis, and mesomelic shortness of the upper limbs, with lower limbs usually being less severely affected and associated with facial dysmorphism and renal abnormality. A case report of a 16-year-old Saudi male presented with four limbs syndactyly of fingers and toes, mild facial dysmorphism, dextroscoliosis, and crossed fused ectopia of the left kidney at the right side is presented here.

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Clinical photographs and video recordings in plastic surgery are indispensable in clinical practice, training, and research. Historically, clinical photography and video recordings were confined to the stringent control of the medical illustration units of hospitals. However, the evolution of social media platforms and smartphone technology has facilitated the rapid exchange of images with a virtual audience of potentially limitless size. The risk to patients is that more people have access to their images, which may be used in ways not authorized or anticipated. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google Scholar, and the bibliographies of published articles, which was by hand searching, using the following keywords: clinical photography, video recordings, social media, smartphone, consent, autonomy, and plastic surgery. This review fills an important gap in the plastic surgery literature by providing ethical guidelines in clinical photography and video recordings.

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Introduction: Soft tissue defects around the knee occour commonly. Various flaps have been described for coverage of these defects around the knee, such as local flaps, cross-leg flap or free flaps etc, but, knee joint function and appearance frequently compromise the outcome. Materials and Methods: A retrospective study comprising of eight patients was conducted in a tertiary level trauma center. Proximal based sural artery fasciocutaneuos flap was used to cover tissue defects. Results: No morbidity of the donor site and no functional deficits of the knee or ankle were detected in any of the cases. All flaps survived without any major complications. Most of the patients were satisfied with this thin and sensate flap. Conclusion: The proximally based sural artery flap is easy to raise and execute. It provides a thin, sensate and good gliding surface. This flap is easy to learn and cosmesis is excellent at the recipient site. Hence the authors recommend it to be ideal choice for the coverage of the defects mentioned in the study.

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Management of soft tissue defects in the distal third of the leg, ankle and foot has evolved over time despite its challenges. No option of coverage is universally recommended for defects in this region of the body. Our objectives were to review and analyze outcomes of reported options of reconstruction of soft tissue defects in this region. We conducted a search of PUBMED and HINARI databases from 2000-2014 to identify reported options of reconstruction of soft tissue defects of the leg, ankle, and foot. Pooled data from suitable articles were analyzed and the success and complication rates as well as the relative risks for failure and complications were computed. One thousand and thirty two articles were retrieved out of which thirty three met the inclusion criteria for analysis. All the 33 articles were uncontrolled cohort and descriptive studies. There were 14 reports on sural artery flap, 6 on perforator-based flaps, and 5 on free flaps. Cross leg flaps, adipofascial, peroneus brevis, and hemisoleus muscle flaps were reported in two studies each while medial plantar, supramalleolar, and skin grafts were reported in one study each. Flap failure was the commonest complication with free flaps while reconstruction with skin grafts had the lowest failure rate. Free flaps were, however, versatile for reconstruction of complex defect. Conclusively, meticulous planning is required in the reconstruction of defects of the lower third of the distal third of the leg, ankle, and foot in order to use the most appropriate method for best outcomes.

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