The 180-Degree Perforator-Based Propeller Flap for Soft Tissue Coverage of the Distal, Lower Extremity

A New Method to Achieve Reliable Coverage of the Distal Lower Extremity With a Local, Fasciocutaneous Perforator Flap

Abstract

Background: 

Traumatic and nontraumatic defects of the distal third of the tibia are challenging in regard to soft tissue coverage. While local, pedicled fasciocutaneous perforator flaps allow adequate coverage, the donor site often requires skin grafting. When a local perforator flap is designed as a 180-degree propeller flap, an excellent esthetic result and direct closure of the donor site can be achieved, with minimal morbidity.

Methods: 

Eight patients with defects in the malleolar region were treated with 180-degree propeller flaps based on perforators from the tibial and peroneal vessels.

Results: 

One partial flap loss was encountered in an insulin-dependent diabetic. Partial superficial epidermolysis was encountered in 2 cases and healed without further interventions. No other complications were encountered. All patients returned to full ambulation within 8 weeks.

Conclusion: 

The 180-degree propeller flap is an elegant and versatile method to achieve soft tissue coverage with local tissue in defects of the distal tibia. Contrary to other local perforator flaps, this specific design facilitates direct closure of the donor site. As only local, thin tissue is used, no interference with normal shoe wear occurs. Even in older patients, this flap has proven to be a reliable option.

In Brief

Eight malleolar defects were reconstructed with 180 propeller flaps based on perforators from the tibial and peroneal vessels, thereby avoiding skin grafts to the donor site. Despite one partial flap loss and two episodes of epidermolysis, all patients were fully ambulatory within 8 weeks.