The Peroneal Artery Perforator-Based Propeller Flap for Distal Lower Limb Reconstruction

Abstract

Background:Reconstruction of soft tissue defects in the lower third of the leg remains challenging. Anatomical constraints limit the number of local flap options, often necessitating microsurgical free tissue transfers to reconstruct defects in these areas. With an increased understanding of the perforator flap concept, we applied the propeller flap design based on the peroneal artery perforators to provide local flap coverage of different defects in this difficult region.Patients and Methods:Between 2002 and 2010, 16 peroneal artery perforator-based propeller flaps were performed for cover of different defects in the pretibial area (n=3), Achilles' tendon and/or hindfoot (n=7) and lateral malleolar area (n=6).Results:The length of the flap ranged from 7.5 to 28 cm, and the width from 3 to 8 cm. Perforator selection depended on the defect location and ranged from 4.5 to 22 cm above the tip of the lateral malleolus. Postoperative venous congestion was encountered in 6 propeller flaps. Most of the congestion subsided within days without complications, except two needed further reconstruction with skin grafts.Conclusion:Peroneal artery perforator-based propeller flaps are reliable and can be designed and harvested with ease. This flap is a good option for covering small defects in the lower third of the leg.