Background: Reconstruction of soft tissue defects in the
leg and the foot remains challenging. Anatomical constraints
limit the options available for reconstructing complex defects
especially lower third of leg. Perforator propeller flaps are
raising interest in reconstructive surgery of the limbs. We
present our experience with perforator propeller flaps for
reconstruction of soft tissue defects in leg and foot with an
emphasis on the safe limit of a perforator flap in the lower
limb.
Methods: The study was carried prospectively and 32
patients with leg or foot defects treated with various perforator
propeller flaps (both elective as well as emergency) were
included in the study. A hand-held ultrasound Doppler was
used pre-operatively and intraoperatively to detect the perforator
vessels.
Results: Out of the 32 cases, we witnessed total flap loss
in one and distal necrosis in 6 cases. In 4 of them the flaps
lengths were more than one third of the limb length. 8 patients
had minor complications which included congestion, infection
or graft loss.
Conclusion: Perforator flaps may represent a good alternative
to the free flaps in the areas were other local reconstructive
procedures are not possible. This is a versatile
technique and with decreased donor site morbidity limited to
a single body area. There is a specific like to like soft tissue
replacement leading to a better cosmetic and reconstructive
outcome. The main drawback of the perforator flaps however
is the higher risk of venous congestion. The incidence of distal
necrosis increases with flap length more than one third of the
limb provided other factors affecting flap vitality are constant.