Perforator-based propeller flaps treating loss of substance in the lower limb

Abstract

BackgroundLocal flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. These flaps allow efficient coverage of large wounds without the need to sacrifice a major vascular axis. The operative technique does not require microvascular anastomosis and allows reconstruction of soft tissue defects using nearby similar tissues. The aim of this study was to evaluate the clinical results of local perforator flaps in the treatment of complex lower-limb defects.Materials and methodsTwenty-two local perforator flaps were retrospectively studied. Loss of substance was due to postsurgical complications in seven cases, oncological resection in six, posttraumatic defect in five, pressure sores in three, and osteomyelitis in one.ResultsPostoperatively, two patients showed partial flap necrosis. In five patients, a superficial epidermolysis occurred. Minor complications were seen in three patients who showed transient venous congestion of the flap. Furthermore, transient leg edema was sometimes observed in patients with large propeller flaps. All but one patient healed without further major surgical procedures. In three cases, secondary skin grafts were performed. In most cases, the aesthetic result was optimal and patients were fully satisfied.ConclusionsWhen characteristics of the defect are suitable for treatment with a propeller-based local flap, this technique should be considered as one of reasonable options for surgical reconstruction. Microsurgical techniques facilitate the management of complex trauma in emergency and may allow planning reconstructive procedures and limb salvage in elective orthopedic surgery.

Proximally Based Anterolateral-Thigh (ALT) Flap for Knee Reconstruction: An Advancement Propeller Perforator Flap

“…The reconstruction technique of the lower limb should ideally replace like-to-like tissue, minimize donor-site morbidity, preserve main vascular trunks, and reduce operating and hospitalization time [12]. The development of propeller flaps in reconstructive microsurgery has been facilitated by improved knowledge of the arterial basis of flap perfusion and anatomical studies on lower limb vascularization provided the basis for local perforator flap design [13].…”

Perforator Based Propeller Flaps in Limb Reconstructive Surgery: Clinical Application and Literature Review

“…Despite this, many authors reported clinical series using propeller flaps for the reconstruction of the lower limb [11, 24–26]. …”

Distally Based Saphenous Neurocutaneous Perforator Flap: A Versatile Donor Site for Reconstruction of Soft Tissue Defects of the Medial Malleolar Region

“…Venous drainage of the angiosome typically occurs through the greater saphenous vein, which has numerous valves that prevent retrograde drainage of the distally based flap (16)(17)(18). However, when harvesting a reverse flap, the reflow blood will still conform to its original direction through the greater saphenous vein; thus, we have routinely sutured the distal end of the greater saphenous vein to facilitate drainage of the flap through the proximal end.…”

“…In general, the most prevalent complication associated with perforator flap tissue transfer has been complete or partial flap loss owing to venous congestion (16,17). Venous drainage of the angiosome typically occurs through the greater saphenous vein, which has numerous valves that prevent retrograde drainage of the distally based flap (16)(17)(18).…”