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A Simplified Protocol Using Septocutaneous Perforator-Based Propeller Flaps for Concurrent Fixation and Coverage of
Pissanu Reingrittha1, Areeya Kamphaengkaew1, Surasak Jitprapaikulsarn1
1Department of Orthopedics, Buddhachinaraj Hospital, 90 Srithamtraipidok Road, Phitsanulok, Thailand 65000.
Background:
Complex fractures of the ankle and hindfoot require timely and reliable soft tissue coverage, challenging in resource-constrained settings.
Purpose:
To evaluate the clinical outcomes of septocutaneous (SC) perforator-based propeller flaps as a simplified, equipment-independent approach, accessible to non-microsurgeons, for concurrent internal fixation and coverage in a resource-constrained setting STUDY DESIGN: Retrospective cohort study.
Methods:
A retrospective, single-centered cohort study of 67 eligible patients with complex ankle and hindfoot fractures (mean defect area 45.3 ± 18.0 cm²) treated with concurrent SC perforator-based propeller flap coverage was conducted from January 2020 to December 2023. Level of necrosis, flap survival, revision rates, bone union time, and functional status measured by the Foot Functional Index (FFI) score at a minimum of one-year follow-up were assessed.
Results:
Concurrent fixation and soft tissue coverage utilizing the SC perforator-based propeller flap achieved complete flap survival across the cohort, with a mean time to definitive surgery of 8.1 ± 4.2 days. Partial necrosis occurred in 19% (13 of 67), all resolving spontaneously by secondary healing. The overall mean FFI score was 14.0 ± 7.6, and the median bone union time was 11 weeks. Partial necrosis significantly delayed bone union (16 vs. 11 weeks; p < 0.001), associated with poorer functional recovery (FFI 22.2 ± 9.9 vs. 12.0 ± 5.4; p < 0.001).
Conclusions:
SC perforator-based propeller flaps provide a reliable, reproducible approach for concurrent fixation and coverage of complex ankle and hindfoot fractures. Preventing partial necrosis is crucial for optimal union time and functional recovery.
Level Of Evidence:
Level III, Retrospective cohort study.
