Anatomic study of propeller flaps based on perforators of the posterior tibial artery

Lower limb injuries resulting from sports activities, industrial accidents, and traffic incidents represent a significant global healthcare challenge. These injuries often entail a high risk of complications, especially when fractures are associated with substantial soft tissue damage. Open fractures classified as Gustilo type II or III are particularly susceptible to complications such as fistula and osteomyelitis. Globally, millions of lower limb injuries are reported annually, leading to considerable morbidity and escalating healthcare costs. The standard treatment for shin ulcers with bone exposure involves the debridement of necrotic tissue, followed by coverage of the defect with well-vascularized tissue. Classical flaps are employed in certain cases; however, their applicability, along with techniques such as pedicled muscle flaps from the rectus abdominis or tensor fasciae latae muscles, depends on the extent and location of the injury. Classical flaps are employed in certain cases, but their applicability depends on the extent and location of the injury. Given these limitations, propeller flaps have emerged as highly effective alternatives for microsurgical reconstruction in lower limb recovery. The objective of our study was to delineate the anatomy and demonstrate the utility of propeller flaps based on the perforators of the posterior tibial artery. By providing detailed anatomical insights, we aimed to highlight the strategic advantages of propeller flaps in complex lower limb reconstruction cases.