Versatility of the Propeller Flap for Reconstructing Defects of Distal Third of the Leg

Soft tissue reconstruction of the leg should be relatively easy to perform, utilize viable tissues similar in skin texture and thickness to those lost, leave the most inconspicuous donor-site defect possible, and be performed without compromising other body parts. Evolution in flap surgery has enabled fasciocutaneous, adipofascial, and super-thin flaps to be harvested for the purpose of reconstruction, thereby minimizing morbidity from muscle inclusion into the flap. The authors present their experience with propeller flaps for reconstruction of soft tissue defects in the lower third of the leg.

This study included 30 patients (20 male, 10 female; aged 16-63 years) with moderate-sized leg defects. There were 18 posterior tibial artery perforator flaps, and 12 flaps were based on perforators of the peroneal artery.

Soft tissue defect dimensions ranged from 9 cm² to 150 cm². Six patients developed complications, including infection, wound dehiscence, and partial flap necrosis. One patient had more than one-third flap loss, which was managed by regular dressing and later by split-thickness skin graft. Mean surgery duration was 2 hours.

The propeller flap is a useful, versatile option for coverage of compound lower limb defects for which there are limited alternative means of coverage.