Perforator propeller flaps for lower extremity soft-tissue defect reconstruction: Shortening the learning curve

Gupta, Samarth; Gupta, Pradeep; Khichar, Pemaram; Mohammad, Arbab; Escandón, Joseph M.; Kalra, Sushrut

doi:10.1016/j.jcot.2022.101831

Cited by 4 publications

(3 citation statements)

References 34 publications

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“…Consequently, pedicled flaps based on the surrounding defect tissue are believed to have a higher risk of flap necrosis compared to FFs harvested from healthy tissue [ 25 ]. Reports on PPF for lower leg skin defects related to trauma often indicate a higher incidence of flap necrosis compared to non-traumatic cases [ 13 , 16 , 26 ], with Vathulya et al [ 8 ] specifically noting a higher complication rate of flap necrosis among pedicled flaps. In our PPF outcomes, the rates of partial necrosis and complete necrosis were 39% and 11%, respectively, mirroring previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…Some surgeons have emphasized the significance of experience in achieving success with the PPF technique in reconstructing lower leg soft tissue defects [ 13 , 16 , 35 ]. However, even experienced surgeons experience flap failure [ 35 ], and some have become cautious about applying PPF for traumatic soft tissue defects and have reverted to FF [ 10 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…While PPF presents certain risks, it undeniably serves as a valuable method [ 3 , 12 , 13 , 17 , 18 ]. To safely apply PPF to lower leg trauma, one must consider various factors beyond patient background and the local conditions of the open wound site.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study

Ota,

Motomiya,

Watanabe

et al. 2024

BMC Musculoskelet Disord

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Background The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction. Methods We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis. Results The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases. Conclusions Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction. Data access statement The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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