Immediate Soft Tissue Reconstruction in Lower Limb Traumas Using Propeller Perforator Flaps

Abstract

Background Open bone fractures represent a demanding clinical condition that can be life- or limb-threatening. For small- to medium-size soft tissue defects of the lower extremity, propeller perforator flaps are a viable option for reconstruction. We report our experience in Gustilo IIIB open fractures treatment with immediate coverage through propeller-based perforator flaps performed in acute setting. Methods Between 2019 and 2022, 94 Gustilo III fractures were admitted to our trauma center, and 28 were Gustilo IIIB fractures. Five patients were eligible for an immediate perforator-based propeller flaps reconstruction. The mean age of the patients was 33.8 years. All of them were male. One of them was a heavy smoker (15 cigarettes per day). No other comorbidities were present. Results The mean operating time, including fracture reduction and fixation time, was 106 minutes. The length of the defect varied between 5 and 7 cm and the width between 3 and 4 cm. We reported no major complications, and none of the patients required a surgical revision of the flap. A patient with smoking habit reported a superficial flap necrosis. The mean follow-up was 5.5 months. No cases of nonunion or osteomyelitis have developed so far. Conclusions The use of perforator-based propeller flaps, in acute trauma setting, has not been reported in literature so far. In our experience, propeller perforator flaps are a viable reconstructive option in immediate reconstruction during the acute management of open fractures.

Plastic Surgery and the Management of Surgical Infections

“…Recent innovations in distal lower extremity propeller flaps are examples of continued plastic surgery refinements to the treatment of distal tibial osteomyelitis. 17…”

“…Leonard Furlow wrote the unique “advantage that we have, being able to transfer and combine experience in one area of the body for innovative use in another area.” 16 Plastic surgeons tailored microsurgery to the management of distal tibial osteomyelitis and will continue to explore ways to adapt techniques to other problems. Recent innovations in distal lower extremity propeller flaps are examples of continued plastic surgery refinements to the treatment of distal tibial osteomyelitis 17 …”