The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction

Abstract

Background: Defects in the distal third of the leg are difficult to cover and often require free tissue transfer, even for defects of limited sizes. Propeller flaps have been designed specifically as an alternative to free tissue transfer but at times have been associated with unacceptably high complication rates. We therefore aimed to prospectively assess our own institutional experience with this technique and to define its role in lower-limb reconstruction. Methods: All patients who had been managed with reconstruction of the distal part of the leg with a propeller flap between 2014 and 2017 were included in the study. Demographic, clinical, and follow-up data on the patients and surgical procedures were recorded with special focus on the complication profile. Results: Twenty-six patients underwent propeller flap reconstruction of the distal part of the leg: 12 flaps were based on the posterior tibial artery, and 14 were based on the peroneal artery. Postoperative complications developed in association with 1 of the 12 flaps based on the posterior tibial artery, compared with 8 of the 14 flaps based on the peroneal artery (p = 0.015). Moreover, the presence of a higher Charlson comorbidity index (≥2) was strongly associated with the development of postoperative complications (p < 0.001). Conclusions: Propeller flaps are a reliable option for traumatic reconstruction in carefully selected patients with lower-limb defects. In our experience, the rate of complications was higher for propeller flaps based on the peroneal artery and for patients with a Charlson comorbidity index of ≥2, whereas posterior tibial artery-based propeller flap reconstruction was a reliable surgical option for patients with a small defect in the distal third of the lower limb. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Efficacy of the Free-Style, Perforator-Plus Flap in the Reconstruction of the Soft Tissue Defects at the Lower Leg and Ankle Regions

“…Lese et al, [43] in their study showed a mean healing-time of 5.9 weeks (range, 2 to 32 weeks). Demiri et al, [50] in their retrospective comparative study between Reverse neuro-cutaneous (Reverse Sural and Lateral Supramalleolar) versus Perforator Propeller flaps for reconstruction of diabetic wounds at foot and ankle, had a mean healing-time of 48.1 (6.9 weeks) for neurocutaneous and 40.7 (5.8 weeks) days for Perforator Propeller flaps.…”

“…In Moullot et al, [30] study, the mean hospital stay for free flaps was 24 days. According to Lese et al, [43] the mean hospital stay for Perforator Propeller flaps was 11.2±3.6 days (range from 7 to 23), with patients who had post-operative complications requiring more weeks until complete healing and staying in the hospital longer. Freestyle Perforator-Plus of Yoon et al, [39] for pressure sore reconstruction, had a mean hospital-stay of 20.1±2.62 SD days (range: 18-26 days) in comparison to perforator-based island flaps mean 22.9± 5.25 SD days (range: 18-35 days).…”

“…Lese et al, [43] used Perforator Propeller flap (n=26) for reconstruction of traumatic defects at the distal leg, with 46% (n=12) flaps PTA-based, and 54% (n=14) flaps were PA-based. They noted 34% post-operative complications; 8% (n=1/12) were for PTA Flaps, and 57% (n=8/14) were for PA Flaps.…”

Evaluation of pedicled flaps for type IIIB open fractures of the tibia at a tertiary care center

“…(5) the area involved (anteromedial, anterolateral, posterolateral, posteromedial, or a combination thereof); (6) type of flap coverage; or (7) complications (partial necrosis, complete necrosis, incidence of infection, and any other complication).…”

Propeller Flaps for Reconstruction around the Foot and Ankle

“…However, a recent study was able to correlate a higher rate of propeller flap problems with an increased number of comorbidities in patients undergoing lower limb reconstruction. 26 It seems clear that heavy smoking, diabetes, and peripheral vascular disease are some of the important issues associated with flap healing problems. 6,23,24 Dealing with the Perforator: How to Avoid Venous Congestion…”