The assessment of the clinical applications of propeller flaps of the lower leg

Abstract

Objective The aim of the present study was to assess the clinical applications of the various propeller perforator flaps for the leg in an attempt to evaluate the results and propose an algorithm for the management of various defects of the lower-third of the leg. Background The ideal method for the soft-tissue reconstruction of the leg should be reliable, relatively easy to perform, offer viable tissues similar in skin texture and thickness to the lost ones (replace like with like), leave the most inconspicuous donor-site defect possible, and be performed without compromising other body parts. The perforator-based propeller flaps have all these advantages. Patients and methods This study included 34 patients who presented with moderate-sized leg defects from August 2013 to June 2015. Out of the 34 patients, 24 were males and 10 were females. Their ages varied from 5 to 50 years with an average age of 27 years. There were 19 posterior tibial artery perforator flaps. There were 12 flaps based on perforators of the peroneal artery. Lastly, there were three anterior tibial artery perforator flaps. Duplex ultrasonography was carried out for 25 patients preoperatively. Results All flaps were based on a single perforator except three cases in which the flaps were based on two adjacent perforators. Fourteen of the flaps were proximally based and 20 were distally based. All flaps were designed as propeller flaps and were rotated from 70° to 180°. The donor site was closed by using split-thickness grafts in all except three cases in which the donor site was closed primarily. Out of the 19 flaps of the posterior tibial artery, 11 (57.5%) healed uneventfully and eight (42.5%) cases were complicated. Out of the 12 peroneal artery propeller flaps, nine (75%) flaps healed uneventfully and three (25%) cases were complicated. Lastly, out of the three cases of the anterior tibial artery propeller flaps, one (33%) healed uneventfully and two (66%) were complicated. Conclusion Propeller flaps based on perforator vessels are raising interest in the reconstructive surgery of the limbs. These flaps allow efficient coverage of large wounds without the need to sacrifice a major vascular axis. The operative technique does not require microvascular anastomosis and allows the reconstruction of soft-tissue defects using nearby similar tissues. The aim of this study was to evaluate the clinical results of propeller perforator flaps in the treatment of various lower-leg defects.