Propeller flap: A feasible flap for distal third of leg defects – two cases done at the plastic surgery unit of The Greater Accra Regional Hospital

Abstract

Introduction: The traditional way of reconstructing soft tissue defects of the lower limb utilized muscle flaps as the ‘gold standard’ for  Gustillo Anderson Grade III B fractures of the upper and middle thirds of the leg. Defects of the lower third of the leg are usually reconstructed with free flaps because of paucity and decreased reach of muscles. In resource constrained environments where free flaps  are not routine with high failure rates, fasciocuataneous flaps are the only option left. We present our experience with the novel pedicled propeller perforator flaps for reconstruction of soft tissue defects in the lower limb.

Case Presentation: Between June and October 2020,  2 consecutive patients - a 34-year-old male and a 51-yearold female, were referred for cover for their distal leg defects from the  Orthopedics and trauma Unit. All patients were operated on under spinal anaesthesia. Perforators from posterior tibial and peroneal  arteries respectively, were identified pre-operatively with handheld doppler and the propeller-pattern skin paddle was designed around  the perforator closest to defect. After elevation of flaps and skeletonization of perforators, they were then rotated (180 degrees) and inset  into defects. Case 1 had whole flap (104 cm2 ) surviving with only minor marginal epidemiolysis at tip whilst the second flap  (58.5cm2 ) had necrosis of only the business end of the flap but subsequently healed by secondary intention after serial dressings. Both  had secondary defects proximally after the rotation, which were skin grafted with 100% take.

Conclusion: Propeller flap in our  experience, is a feasible versatile option for reconstruction of soft tissue defects in the distal third of the leg.