The Versatility of Perforator-Based Propeller Flap for Reconstruction of Distal Leg and Ankle Defects

Abstract

Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4 cm × 3.5 cm to 7 cm × 5 cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result.

Free versus perforator‐pedicled propeller flaps in lower extremity reconstruction: What is the safest coverage? A meta‐analysis

“…A total of 1,802 references of free flap were identified and we included 36 studies that discussed 1,226 free flaps used to treat 1,226 patients (Table ). For the pedicled‐propeller flap, a total of 616 references was identified and we included 19 studies . The 19 articles selected discussed 302 pedicled‐propeller flaps performed in 302 patients (Table ).…”

“…For the pedicled-propeller flap, a total of 616 references was identified and we included 19 studies. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] The 19 articles selected discussed 302 pedicled-propeller flaps performed in 302 patients ( Table 2).…”

A review of propeller flaps for distal lower extremity soft tissue reconstruction: Is flap loss too high?

“…The group repaired defects in all regions of the lower leg, with reported complication rates being 9% complete and 12% partial flap loss rate . Several groups have described this flap in much smaller numbers of patients, but overall with good results . More recently, Robotti et al and Tos et al presented series of 24 and 13 flaps, respectively.…”

Colgajo fasciocutáneo sural inverso para cobertura de defectos de partes blandas en pierna, tobillo y pie. [Reverse­ fasciocutaneous­ sural­ flap­ for­ soft-tissue­ coverage­ in­ the­ leg,­ ankle­ and­ foot­]

“…[5][6][7] en esta serie, el uso del colgajo fasciocutáneo sural de base distal nos permitió cubrir con éxito 20 defectos de tejidos blandos que afectaban la tibia distal, el tobillo y el pie, tanto en reconstrucciones postraumáticas como en defectos secundarios a resecciones oncológicas.…”