Imaging and Surgical Principles of the Propeller and Perforator Flaps of the Lower Limb

Background Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery, University of Palermo. In these patients, we evaluated location and causes of defects, types of flaps used, recipient vessels, complications, time to healing, and aesthetic outcome. Results A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four). Recovery time and hospitalization period were eventually shorter in patients with FFs, due to lower rate of complications and revision surgery. Conclusion In the past years, our indications for reconstruction with PPFs in the lower limb have become more restricted, while we favor reconstruction with FFs. Recommendations are provided to orient surgical treatment in small, medium, and large lower limb defects.

Download Full-text

Lower limb perforator flaps: Current concept

Annales de Chirurgie Plastique Esthétique ◽

10.1016/j.anplas.2020.06.009 ◽

2020 ◽

Vol 65 (5-6) ◽

pp. 496-516

Author(s):

B. Chaput ◽

T. Meresse ◽

F. Bekara ◽

J.L. Grolleau ◽

D. Gangloff ◽

...

Keyword(s):

Lower Limb ◽

Current Concept ◽

Perforator Flaps

Download Full-text

Pedicled Perforator Flaps for the Lower Limb

Seminars in Plastic Surgery ◽

10.1055/s-2006-941717 ◽

2006 ◽

Vol 20 (2) ◽

pp. 103-111 ◽

Cited By ~ 40

Author(s):

Omar Quaba ◽

Awf Quaba

Keyword(s):

Lower Limb ◽

Perforator Flaps

Download Full-text

The suprafascial course of lower leg perforators: An anatomical study

Archives of Plastic Surgery ◽

10.5999/aps.2019.00962 ◽

2020 ◽

Vol 47 (2) ◽

pp. 165-170 ◽

Cited By ~ 2

Author(s):

Luca Vaienti ◽

Giuseppe Cottone ◽

Francesco De Francesco ◽

Francesco Borelli ◽

Giovanna Zaccaria ◽

...

Keyword(s):

Lower Limb ◽

Anatomical Study ◽

Anatomical Variations ◽

Lower Leg ◽

Present Knowledge ◽

Perforator Flaps ◽

Surgical Exploration ◽

Branching Patterns

Background Perforator mapping has been well described in the literature. Once the suprafascial plane is reached, the course of perforators is considered constant. However, the surgeon must be aware of whether an anastomosis exists between perforators superficially to the fascia, in order to choose the best vessel upon which to base the reconstruction. Our retrospective <i>in vivo</i> anatomical study of lower leg perforator flaps presents the first description of variations in the suprafascial path of perforators, which may influence preoperative flap design.Methods An anatomical study of lower limb perforators was performed on 46 nonconsecutive patients who were referred to our department from June 2012 to October 2018. Reconstruction with perforator-based propeller flaps was planned for each of the patients. In total, 72 perforators were preoperatively identified and surgically isolated. The suprafascial course of each perforator was reported.Results During suprafascial surgical exploration, branching patterns were observed in four perforators. These perforators had been classified as single vessels in the preoperative ultrasonographic analysis. However, after surgical dissection, distal converging branches were noted in two of them.Conclusions Our study is the first description in the literature of suprafascial converging perforators, which might constitute an obstacle to planned reconstruction procedures. Despite the accuracy of preoperative evaluations, anatomical variations were present. Knowledge of suprafascial perforator variations may help surgeons to choose the correct perforator upon which to base a planned flap.

Download Full-text

Perforator flaps for reconstruction of lower limb defects

International Surgery Journal ◽

10.18203/2349-2902.isj20163583 ◽

2016 ◽

pp. 2109-2114 ◽

Cited By ~ 1

Author(s):

Mir Yasir ◽

Adil Wani ◽

Haroon Zargar

Keyword(s):

Lower Limb ◽

Perforator Flaps ◽

Limb Defects

Download Full-text

Thin Perforator Flaps for Reconstruction of the Lower Extremity

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-1695740 ◽

2019 ◽

Author(s):

Peggy J. Ebner ◽

Daniel J. Gould ◽

Ketan M. Patel

Keyword(s):

Lower Limb ◽

Lower Leg ◽

Soft Tissue Coverage ◽

Patient Centered ◽

Perforator Flaps ◽

Limb Reconstruction ◽

Flap Survival ◽

Flap Transfer ◽

Viable Solution ◽

Lower Limb Reconstruction

AbstractThin flaps, a modification of traditional flaps that minimize the need for debulking and revision, offer unique advantages in the field of lower limb reconstruction. Advances in the field of microsurgery have made this streamlined method of reconstruction a viable solution for soft tissue coverage in patients with both trauma and nonhealing wounds. Better understanding of anatomy has allowed for flap harvest above the fascia level and the Scarpal plane. These modifications allow for flap transfer with thicknesses more comparable to the native anatomy of the lower leg, ankle, and foot. Flap survival is comparable to traditional techniques with greater potential for improved patient-centered outcomes.

Download Full-text