Propeller Flaps for Reconstructing Leg and Foot Defects: The Relation between Flap Length and the Incidence of Ischemia

Shoeib, M A; Youssef, Gamal; Gaber, Ahmed; Saber, Ahmed; Gomaa, Emad

doi:10.21608/ejprs.2019.65080

Propeller Flaps for Reconstructing Leg and Foot Defects: The Relation between Flap Length and the Incidence of Ischemia

Document Type : Original Article

Authors

The Department of Plastic Surgery, Sohag University Hospital, Sohag, Egypt

10.21608/ejprs.2019.65080

Abstract

Background: Reconstruction of soft tissue defects in the
leg and the foot remains challenging. Anatomical constraints
limit the options available for reconstructing complex defects
especially lower third of leg. Perforator propeller flaps are
raising interest in reconstructive surgery of the limbs. We
present our experience with perforator propeller flaps for
reconstruction of soft tissue defects in leg and foot with an
emphasis on the safe limit of a perforator flap in the lower
limb.
Methods: The study was carried prospectively and 32
patients with leg or foot defects treated with various perforator
propeller flaps (both elective as well as emergency) were
included in the study. A hand-held ultrasound Doppler was
used pre-operatively and intraoperatively to detect the perforator
vessels.
Results: Out of the 32 cases, we witnessed total flap loss
in one and distal necrosis in 6 cases. In 4 of them the flaps
lengths were more than one third of the limb length. 8 patients
had minor complications which included congestion, infection
or graft loss.
Conclusion: Perforator flaps may represent a good alternative
to the free flaps in the areas were other local reconstructive
procedures are not possible. This is a versatile
technique and with decreased donor site morbidity limited to
a single body area. There is a specific like to like soft tissue
replacement leading to a better cosmetic and reconstructive
outcome. The main drawback of the perforator flaps however
is the higher risk of venous congestion. The incidence of distal
necrosis increases with flap length more than one third of the
limb provided other factors affecting flap vitality are constant.

Keywords

Main Subjects

Reconstructions post

References

Gillies H.D. and D.R. Millard: The principles and art of
plastic surgery. Vol. 2. 1957: Little, Brown, 1957.
2- Lister G. and L. Scheker: Emergency free flaps to the
upper extremity. Journal of Hand Surgery, 13 (1): p. 22-
28, 1988.
3- Jayes P.H.: Cross-leg flaps: A review of sixty cases. British
Journal of Plastic Surgery, 3: p. 1-5, 1950.
4- Quaba O. and Quaba A.: Pedicled perforator flaps for the
lower limb. In Seminars in Plastic Surgery, Thieme Medical
Publishers, 2006.
5- Fayman M.S., et al.: The distally based split soleus muscle
flap. British Journal of Plastic Surgery, 40 (1): p. 20-26,
1987.
6- Ponten B.: The fasciocutaneous flap: Its use in soft tissue
defects of the lower leg. British Journal of Plastic Surgery,
34 (2): p. 215-220, 1981.
7- Koshima I., et al.: The vasculature and clinical application
of the posterior tibial perforator-based flap. Plastic and
Reconstructive Surgery, 90 (4): p. 643-649, 1992.
8- Tanaka K., et al.: An anatomic study of the intermuscular
septum of the lower leg; branches from the posterior tibial
artery and potential for reconstruction of the lower leg
and the heel. Journal of Plastic, Reconstructive & Aesthetic
Surgery, 59 (8): p. 835-838, 2006.
9- Taylor G.I.: The angiosomes of the body and their supply
to perforator flaps. Clinics in plastic surgery, 30 (3): p.
331-342, 2003.
10- Hallock G.G.: Lower extremity muscle perforator flaps
for lower extremity reconstruction. Plastic and Reconstructive
Surgery, 114 (5): p. 1123-1130, 2004.
11- Schaverien M. and M. Saint-Cyr: Perforators of the lower
leg: Analysis of perforator locations and clinical application
for pedicled perforator flaps. Plastic and Reconstructive
Surgery, 122 (1): p. 161-170, 2008.
12- Georgescu A.V., et al.: Microsurgical nonmicrovascular
flaps in forearm and hand reconstruction. Microsurgery,
27 (5): p. 384-394, 2007.
13- Acland R., et al.: The saphenous neurovascular free flap.
Plastic and reconstructive surgery, 67 (6): p. 763-774,
1981.
14- Hyakusoku H., T. Yamamoto and M. Fumiiri: The propeller
flap method. British Journal of Plastic Surgery, 44 (1): p.
53-54, 1991.
15- Wei F.C. and S. Mardini: Free-style free flaps. Plastic and
reconstructive surgery, 114 (4): p. 910-916, 2004.
16- Yildirim S., G. Taylan and T. Aköz: Freestyle perforatorbased
VY advancement flap for reconstruction of soft
tissue defects at various anatomic regions. Annals of
plastic surgery, 58 (5): p. 501-506, 2007.