Perforator propeller flaps for lower extremity soft-tissue defect reconstruction: Shortening the learning curve |
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| Institution: | 1. Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital Jaipur, Rajasthan, India;2. Aarupadai Veedu Medical College and Hospital, Puducherry, India;3. Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA;1. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India;2. Dept. of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India;1. Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina;2. Scientific Advisory Committee, British Hospital of Buenos Aires, Buenos Aires, Argentina;1. Departments of Orthopedics, Southport and Ormskirk NHS Trust, Southport, UK;2. Departments of Musculoskeletal Radiology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK;3. Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK;4. Departments of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, UK;5. Departments of Surgery, Altnagelvin Area Hospital, Glenshane Road, Londonderry, UK;1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK;2. Stoke Mandeville Hospital NHS Trust, Mandeville Road, Ayelsbury, HP21 8AL, UK;3. Northampton General Hospital, Cliftonville, NN1 5BD, UK;4. James Paget Hospital, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, NR31 6LA, UK;5. Royal Berkshire Hospital NHS Trust, London, Reading, RG1 5AN, UK;1. Ann & Robert H Lurie Children''s Hospital of Chicago, Division of Orthopaedic Surgery and Sports Medicine, 225 East Chicago Avenue, Box 69 Chicago, Illinois, 60611, USA |
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| Abstract: | BackgroundThe perforator propeller flap is an advantageous option for soft tissue reconstruction in the lower limb as it ensures the preservation of the main artery and muscle, eliminates the need for microsurgical reconstruction as well as provides “like with like” resurfacing of the defects. Despite this, it remains a technically demanding reconstructive option for residents and surgeons with little experience in perforator dissection. We aimed to evaluate the clinical outcomes of our patients whose soft tissue defects were addressed with propeller flaps.MethodsA retrospective study of all propeller flap based reconstruction done on patients with soft tissue defects involving the distal third of the leg was undertaken from August 2018 to December 2020.Results28 patients were treated with propeller flaps for various lower extremity defects. The median defect size was 12 cm2. The posterior tibial artery (PTA) was used in eleven cases (39.3%) and the peroneal artery (PA) in seventeen of the cases (60.7%). The complication rate was 28.6% (n = 8). The complete flap necrosis rate was 10.7% (n = 3) and partial flap necrosis rate was 7.1% (n = 2), The rate of venous congestion was 7.1% (n = 2) and wound dehiscence occurred in 3.5% (n = 1). There was a significant negative correlation between the number of cases performed by a resident and the operative time.ConclusionAlthough propeller flaps are a reliable option to address lower extremity defects, they have a long learning curve and require a good amount of experience and perforator dissection skills to reduce the probability of flap failure. We are of the opinion that residents should be adequately trained in this procedure to ensure optimal outcome delivery. |
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| Keywords: | Lower limb reconstruction Perforator artery flap Propeller flap Posterior tibial artery Peroneal artery Resident |
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