Abstract
Perforator-pedicled propeller flaps, which base their blood supply on isolated perforators, have been gaining popularity among plastic surgeons over the past two decades. They have proven to be of great value in the reconstruction of soft tissue defects in different areas of the body but are, thanks to their maximal mobility, mostly used in the reconstruction of extremities. In this article, we focus on perforator-pedicled propeller flaps in lower limb reconstruction, where they can be implemented in the coverage of primary as well as secondary soft tissue defects. Firstly, a brief literature review on evolution of propeller flap use in lower extremity is provided. Moreover, we present our surgical technique including the use of indocyanine green real-time angiography for reliable flap transfer. In addition, we report 3 cases of patients in whom we used a local propeller flap for the closure of skin defects in different parts of the leg.
Highlights
Reconstruction of soft tissue defects in the lower limb is known to be difficult due to the lack of spare local tissue in the immediate vicinity of such defects[1]
The first authors to use the term “propeller flap” were Hyakusoku et al.[5] in 1991. His group designed an adipocutaneous flap with a skin island of a length largely exceeding its width, based on a random pedicle in the center, on which the flap was rotated through 90° similar to a propeller to release burn scar contractures in the cubital and axillary regions
Thanks to the advances in microsurgical techniques and anatomical knowledge, perforator flaps have been developed, where a skin island flap is harvested without the underlying muscle
Summary
Reconstruction of soft tissue defects in the lower limb is known to be difficult due to the lack of spare local tissue in the immediate vicinity of such defects[1]. A local perforator flap measuring 16 cm × 4 cm, based on a Y-shaped perforator of the peroneal artery perforator [Figure 2], was harvested and propelled 180° into the defect [Figure 3]. In this way, the soft tissue defect from the debridement and the plate were covered with an undamaged tissue. A pedicle anterolateral thigh flap measuring 14 cm × 8 cm, based on a perforator of the descending branch of the lateral femoral circumflex artery, was raised [Figure 8, lower left]. The wound healed well, the patient was cancer free, and no gait disturbance was observed five months after the operation [Figure 9, right]
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