Lower limb reconstruction using the islanded posterior tibial artery perforator flap

The islanded propeller-design posterior tibial artery perforator flap is a versatile local reconstructive option for defects of the lower leg, ankle, heel, and foot.

A retrospective review of patients undergoing this procedure from 1989 to 2009 was performed. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes.

One-hundred six flaps were islanded on a single perforator from the posterior tibial artery in 100 patients (six bilateral). Seventy-two percent of defects were at the lower third of the leg, and 10 percent were at the ankle, heel, or foot. The median angle of rotation about the perforator was 160 degrees (range, 60 to 180 degrees). Eighty-eight percent of flaps had associated fractures, 60 percent were managed using intramedullary nailing, and 44 percent were Gustilo grade IIIb fractures. Five percent of patients subsequently developed osteomyelitis, and the primary nonunion rate was 9 percent. There was an 8.5 percent complete and 12 percent partial flap failure rate, both associated with cigarette smoking, diabetes, and peripheral vascular disease. Limb salvage for complete flap failures included free muscle flap transfer in six cases and below-knee amputation in three cases.

The islanded propeller-design posterior tibial artery perforator flap provides reliable coverage of lower limb defects, particularly of the lower third.