A Modified Supine Positioning Setup for Diabetic Foot Reconstruction with Peroneal Artery Perforator Based Propeller Flap: Technique Tips and Tricks

Background: Wounds on the distal third of the lower extremity are reconstructively challenging, as there is lack of spare local tissue to design local flaps from. The perceived alternative is to perform free flaps to cover for these defects. Drawbacks include the need for specific training to perform microsurgery, longer time required, and the probable bulkiness when donor is obtained from certain areas. The perforator propeller flap is a local island fasciocutaneous flap, designed with 2 blades of skin island of unequal length extending from each side of the perforator. As the flap is rotated, the longer blade will cover the defect. Patient and Method: A case of soft tissue defect on the achilles is reported, with successful defect closure by utilizing a peronal artery perforator based fasciocutaneous propeller flap with 180 degree rotation and vein supercharge to facilitate backflow. Secondary defect required split-thickness skin grafting. Result: After surgery, muscles of the lower limb started to swell and get compromised. We removed some stitches to allow soft tissue expansion underneath the flap. after the release, flap perfusion improved. Stitches were left open for 3 days, then closure of flap edges by placing gradual traction sutures which were tightened daily. By the 7th day, flap edges was re-approximated and the skin grafts took well. Summary: The ability of the propeller flap to rotate makes this flap highly useful and versatile for the reconstruction of distal lower limb defects. Flap dimension can be enhanced when distal part of the flap is supercharged to neighboring recipient vessels. Another advantage is the close vicinity of donor, giving better aesthetic result.6

Download Full-text

Peroneal artery perforator-based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: Case report and literature review

Microsurgery ◽

10.1002/micr.20557 ◽

2008 ◽

Vol 28 (8) ◽

pp. 663-670 ◽

Cited By ~ 47

Author(s):

Ariel N. Rad ◽

Navin K. Singh ◽

Gedge D. Rosson

Keyword(s):

Case Report ◽

Literature Review ◽

Lower Extremity ◽

Peroneal Artery ◽

Flap Reconstruction ◽

Propeller Flap ◽

Tumor Extirpation ◽

Artery Perforator

Download Full-text

Recycling delayed perforator flap: Deep inferior epigastric artery perforator-based propeller flap from a prior vertical rectus abdominis musculocutaneous flap

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2011.01.020 ◽

2011 ◽

Vol 64 (9) ◽

pp. 1238-1241 ◽

Cited By ~ 2

Author(s):

Ju Young Go ◽

So Young Lim ◽

Goo Hyun Mun ◽

Sa Ik Bang ◽

Kap Sung Oh ◽

...

Keyword(s):

Perforator Flap ◽

Rectus Abdominis ◽

Musculocutaneous Flap ◽

Inferior Epigastric Artery ◽

Propeller Flap ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery ◽

Artery Perforator

Download Full-text

Dorsal metacarpal artery perforator-based propeller flap for complex defect of the dorsal aspect in the index finger

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408100121 ◽

2009 ◽

Vol 34 (6) ◽

pp. 807-809 ◽

Cited By ~ 10

Author(s):

Bruno Battiston ◽

Stefano Artiaco ◽

Andrea Antonini ◽

Valentina Camilleri ◽

Pierluigi Tos

Keyword(s):

Index Finger ◽

Complex Defect ◽

Dorsal Aspect ◽

Propeller Flap ◽

Dorsal Metacarpal Artery ◽

Artery Perforator

Download Full-text

Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1667363 ◽

2018 ◽

Vol 35 (02) ◽

pp. 117-123 ◽

Cited By ~ 7

Author(s):

Jocelyn Lu ◽

Michael DeFazio ◽

Chrisovalantis Lakhiani ◽

Michel Abboud ◽

Morgan Penzler ◽

...

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Diabetic Foot ◽

Functional Outcomes ◽

Free Tissue Transfer ◽

Major Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Flap Survival ◽

Foot Reconstruction

Background Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. Methods Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K.K.E.). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated. The lower extremity functional scale (LEFS) score was used to assess functional outcomes after surgery. Results Overall rates of flap success and lower limb salvage were 93 and 79%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. Seven patients in this series ultimately required below-knee amputation secondary to recalcitrant infection (n = 5), intractable pain (n = 1), and limb ischemia (n = 1). The average interval between FTT and major amputation was 8 months (r, 0.2–15 months). Postoperative ambulation was confirmed in 25 patients (86%) after a mean final follow-up of 25 months (r, 10–48 months). The average LEFS score for all patients was 46 out of 80 points (r, 12–80 points), indicating the ability to ambulate in the community with some limitations. Conclusion FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation. However, several patients will eventually require major amputation for reasons unrelated to ultimate flap survival. These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.

Download Full-text