Perforator-based propeller flaps for leg reconstruction in pediatric patients

Abstract

Perforator-based propeller flaps provide adequate soft tissue coverage for leg reconstruction. The aim of this study was to assess the versatility and reliability of the use of propeller flaps for leg reconstruction in pediatric patients. Seven male pediatric patients ranging in age from 2 to 13 years with a mean age of 6.7 underwent perforator-based propeller flap surgery over a four-year period. The defects resulted from burn injuries (n=4) and traffic accidents (n=3). The injuries were located on the ankles of four patients and on the knee, anterior lower tibia, and foot dorsum of the other three patients, respectively. The flap sizes ranged from 5×3 to 10×6cm with a mean flap size of 7.6×4.3cm. Flap harvesting time ranged from 38 to 56m with a mean of 46m. The rotation degree range of the flaps was from 90° to 180°. The propeller flaps were based on the posterior tibial artery (n=4), anterior tibial artery (n=2), and the descending branch of the lateral circumflex femoral artery (n=1). All flaps survived completely without surgical complication; however, one patient developed disseminated intravascular coagulation syndrome two days post-surgery and died within four days. Perforator-based propeller flap reconstruction is a safe, reliable, and versatile method for lower extremities in pediatric patients; however, it requires meticulous surgical dissection and extreme patience during the surgical procedure.