Two propeller flaps in a distal lower leg with bilateral defects as a single-stage procedure: A case report

Soft tissue defects in the lower leg often represent a therapeutic challenge. One of the treatment modalities is plastic reconstruction with a propeller flap. In our case report, we would like to present a case of a 75-year-old, multimorbid female patient who developed in the right distal lower leg, both medial and lateral, soft tissue defects after open reduction and internal fixation of a complex ankle fracture. She was treated by the single surgeon with two propeller flaps, one lateral and one medial, in the same operation. With this single-stage procedure, we achieved effective, long-term closure of the defect. It resulted in several advantages for the patient, including a shorter operation time compared to hypothetic two free flaps and no additional prolonged anesthesia. Also, defects were reconstructed according to the "like with like" principle, and less donor site morbidity compared to free muscle flaps. The disadvantage of the procedure was the need for split skin graft of the donor sites. Based on our experience, this method could be an option for carefully selected patients without high aesthetical demands who have undergone appropriate preoperative systemic and local optimization.