Propeller Flaps in Lower Limb Reconstruction: Case Series

Abstract

Introduction: Traditionally in reconstruction of lower limb soft tissue defects, muscle flaps have been the ‘Gold Standard’ for Gustillo Anderson Grade III B fracture involving upper and middle third defects. Lower third defects were usually reconstructed with free flaps. Evolution in flap surgery has enabled  fasciocutaneous, adipofascial and superthin flaps to be harvested for the purpose of reconstruction thereby minimizing morbidity from muscle inclusion into the flap. We present our experience with  perforator (propeller) flaps for reconstruction of soft tissue defects in the lower limb. Materials and methods: Between February 2010 and April 2010, 6 consecutive patients, 34 years (18-50 years old), were referred to our services post trauma to the lower extremity. This case series consists of patients from two separate centers in Malaysia. All wounds were classified as Gustillo Anderson Grade IIIB. All patients were operated under spinal anaesthesia. Perforators were identified and traced to major limb vessel and skin paddle was designed around the perforator. Skin paddle was then rotated into the defect in the lower third of the leg. Results: All the patients tolerated the procedure well. There was one case of epidermolysis, however the remainder of the flap survived and wound healed completely. Two flaps based on the peroneal artery initially underwent distal congestion but however improved on day three post-operatively. All six flaps survived 100% post inset for middle and distal third leg reconstruction. Conclusion: Propeller flaps in our experience is a versatile option for reconstruction of lower leg soft tissue defects with associated Grade IIIB open fractures.