Evaluation of outcomes after coverage of exposed tibia with propeller-based perforator flaps
Keywords:Defect, Reconstruction, Propeller, Flap, Perforator
Background: For small-and medium-sized soft-tissue defects in lower one third of leg without any degloving injury, the perforator propeller flaps are the authors preferred choice. With the study we shall present our experience with the use of three (tibio-peroneal system) perforator-based propeller flaps in the reconstruction of distal leg defects.
Methods: A prospective study was conducted in the department of plastic and reconstructive surgery, over a period of 20 months from 1st January 2017 to 30th September 2018. All patients with small to large sized soft tissue defects affecting lower third of tibia were included in the study. Various findings were recorded and analyzed.
Results: Among the affected areas that required coverage of soft tissues of the leg, in order of frequency, the middle third represented 15 cases (62.5%), and in the distal third 9 cases (37.5%). Flap dimensions ranged from 12 to 156 cm2, with an average size of 50 cm2. The flap rotation was 180 degrees in 19 cases (79.17%), 140 degrees in 3 cases (12.50%), and 160 degrees in 2 cases (8.33%). The flaps were based on a single perforating vessel of the posterior tibial artery in 12 cases (50%) of the cases; on the anterior tibial artery in 09 cases (37.5%), and in 3 cases (12.5%) the peroneal artery was chosen. Complications were present in 14% of the flaps.
Conclusions: We concluded that the perforator-based propeller flaps are ideal in reconstructing small-medium defects of the middle and distal third of the leg.
Ger R. The technique of muscle transposition in the operative treatment of traumatic and ulcerative lesions of the leg. J Trauma. 1971;11(6):502-10.
McCraw JB, Dibbell DG. Experimental definition of independent myocutaneous vascular territories. Plast Reconstr Surg. 1977;60(2):212-20.
Manchot C. The cutaneous arteries of the humanbody. New York: Springer-Verlag; 1982: 105-114.
Filatov VP. Plastic procedure using a round pedicle. Vestn Oftalmol. 1917;34:149.
Cormack G, Lamberty B. The arterial anatomy of skin flaps. Edinburgh (UK): Churchill Livingstone; 1986: 236–43.366–7.
Cormack G, Lamberty B. The anatomical basic for fasciocutaneous flaps. Cambridge (MA): Blackwell Scientific Publications. 1992.
Koshima I, Soeda S. Inferior epigastric artery skinflaps without rectus abdominis muscle. Br J Plast Surg. 1989;42(6):645-8.
Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg. 1991;44:53-4.
Taylor GI, Palmer JH. The vascular territories (angiosomes)of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(2):113-41
Mardini S, Tsai FC, Wei FC. The thigh as a model for freestyle free flaps. Clin Plast Surg. 2003;30(3):473-80.
Taylor GI, Daniel RK. The free flap: composite tissue transfers by vascular anastomosis. Aust N Z J Surg. 1973;43(1):1-3.
McCraw JB, Dibbell DG, Carraway JH. Clinical definition of independent myocutaneous vascular territories. Plast Reconstr Surg. 1977;60(3):341-52.
Bakamjian VY. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg. 1965;36:173-84.
Manchot C. Die hautarterien de menschlichenkorpers. Leipzig: FCW Vogel. 1889.
Taylor GI, Daniel RK. The free flap: composite tissuetransfer by vascular anastomosis. Aust N Z J Surg. 1973;43(1):1-3.
Wei FC, Jain V, Suominen S. Confusion amongperforator flaps: what is a true perforator flap? Plast Reconstr Surg. 2001;107(3):874-6.
Rhodin J. The ultrastructure of mammalian arterioles and precapillary sphincters. J UItrastr Res. 1967;18:81-223.
Rhodin J. Ultrastructure of mammalian venous capillaries, venules and small collecting veins. J Ultrastr Res. 1968;15:452-500.
Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg. 1981;34(2):215-20.
Salmon M. Arteres de la peau. Paris: Masson. 1936.