Comparative analysis of propeller flaps vs. modified perforator-based flaps in foot and ankle reconstruction

Abstract

Lower leg, ankle, and foot defects pose a challenge for the surgeon due to the thin soft tissue cover and presence of important structures like bone, tendons, ligaments, and neurovascular bundles superficially. Since this region is prone to trauma and infection, the need arises to select an ideal flap to give a stable soft tissue cover. Propeller and perforator-based flaps are the most commonly used local flaps which can offer a durable soft tissue cover. However, they have disadvantages. Propeller flaps are more prone to venous congestion which can lead to partial or complete flap failure. Perforator-based flaps do not enjoy the freedom of rotation like propeller flaps. In this study we present a simple modification in perforator-based flaps by retaining a thin continuity of subcutaneous tissue to the minor blade of the perforator flap, which can be rotated up to 180° like propeller flaps, thus avoiding the complications of venous congestion. All patients in whom perforator-based flaps were used in the reconstruction of the lower leg, foot, and ankle region from November 2015 to January 2019 were incuded in this study. Degree of rotation, venous congestion grade, and success rate between modified-perforator flaps (MPF) and propeller flaps were compared. A total of 47 patients were included in the study. In 27 cases, traditional propeller flap technique was used. Eight cases presented with complications. In the 20 cases where a MPF was performed, one partial flap loss was observed. The mean degree of rotation was significantly higher in the MPF group (155°) if compared with the propeller flap group (137.6°) (p = 0.003).There was a statistically significant reduction in incidence of venous congestion in the MPF group (p = 0.019). The MFP herein presented seems a simpler solution to reconstruct foot and lower leg defects as it has a lesser complication rate in comparison with traditional propeller flaps. Level of evidence: Level III, therapeutic study.