Perforator Propeller Flaps for the Coverage of Middle and Distal Leg Soft-tissue Defects

Abstract

Background:Local propeller flaps preserve the main vascular arteries of the lower extremity and muscle function, avoiding the need for a microsurgical anastomosis and the benefit of providing a “like with like” coverage. Our goal in this study was to demonstrate the versatility, safety, and complications of the local propeller flaps for lower extremity reconstruction.Methods:We present a series of 28 patients in whom we used local propeller flaps to restore small-to-medium soft-tissue defects of the lower limb in different hospitals of Managua, Nicaragua.Results:Flap average dimensions were of 48 cm2. Flap rotation was performed in 180 degrees in 85% of the cases. The propeller flaps were based on a single perforator, from the posterior tibial artery in 50%, anterior tibial artery in 39.3%, and peroneal artery in 10.7% of the cases. Complications occurred in 14% of the propeller flaps performed, with 3 partial necrosis of less than 15% of the flap transposed. Complications of the patients occurred in both sex groups; however, for the female group, there was a 75% of complications with a tendency toward statistical significance of P = 0.038. Donor site of the flap was closed primarily in 85.7% (24) of the cases.Conclusions:In our opinion, the availability and safety of local propeller flaps, justifies its use in cases where microsurgical techniques are not an option for the reconstruction of the middle and distal extremity, in small-to-medium defects of soft-tissue coverage of the lower limb.

Coverage of exposed bone and hardware of the medial malleolus with tibialis posterior artery perforator flap after ankle fracture surgery complications

“…Mendieta et al reported that they used PTAPF in 14 of 28 patients with lower extremity soft tissue defects after trauma. They observed partial flap necrosis in 3 patients in their series and all the partial flap necrosis were observed in PTAPF group …”

“…They observed partial flap necrosis in 3 patients in their series and all the partial flap necrosis were observed in PTAPF group. 2 The planning of the flaps outside the zone of injury is an important factor for the flap viability in reconstruction of high-energy injuries, and the risk of perforator F I G U R E 4 A, Preoperative X-ray and B, preoperative picture of the 39-year-old female patient with exposed plaque over the medial malleolar region after trimalleolar fracture surgery. C, Elevation of the flap over tibialis posterior artery perforator pedicle adjacent to the defect area.…”

“…High‐energy traumas in lower extremities are common and ankle fractures are among the most common orthopaedic surgical procedures . Reconstruction of soft tissue defects related to the complications of ankle fracture surgery is a challenging problem due to bone prominences and lack of local soft tissue …”

“…1 Reconstruction of soft tissue defects related to the complications of ankle fracture surgery is a challenging problem due to bone prominences and lack of local soft tissue. 2 Treatment options are limited in reconstruction of this region. Free flap transfers have become the first choice in the reconstruction of wide soft tissue defects involving distal lower extremity.…”

Colgajo de perforante de la arteria tibial posterior. Serie de casos. [Posterior tibial artery perforator flap. Case series]

“…Los defectos de cobertura en el miembro inferior, particularmente en la pierna, son un problema difícil de solucionar, debido a las características propias de la región anatómica, como la presencia de prominencias óseas, la escasez de tejidos blandos y la elasticidad limitada de la piel. 1,2 En el pasado, las alternativas reconstructivas locales eran los colgajos de gastrocnemio y sóleo, y su uso estaba limitado al tercio proximal y medio de la pierna; 3 la reconstrucción del tercio distal de la pierna quedaba supeditada a opciones complejas, como un colgajo cross-leg o un colgajo microquirúrgico, 2,4 ambos procedimientos no exentos de complicaciones y con fracasos del 15 al 20%. 5 A su vez, es importante destacar que no todos los pacientes tienen condiciones óptimas para aplicar estos procedimientos, lo que, sumado a su complejidad, dificultan su realización.…”