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Perforator-Based Propeller Flaps for Distal Leg Reconstruction

February 10, 2018

Contributors: Bart M Berghs, MD; Francis Bonte, MD; Jean F Goubau, MD, PhD; Koen Mermuys, MD; David Van Schaik, ACNP-BC, ATC, BA, BOC, BOCO, BOCP, BS; Laurent B Willemot, MD; Bert Vanmierlo, MD; Bert Vanmierlo, MD

Defects of the distal leg and ankle are reconstruction challenges. Because of a limited amount of available local tissue and concerns with regard to the vascularity of the lower leg, free flaps often are preferred over pedicle flaps. The reverse-flow sural artery flap is a reliable local tissue transfer technique. However, this flap is associated with limitations, including considerable donor site morbidity and less reliability in patients with local soft-tissue damage or previous scarring. Few valuable anatomic studies are available on the perforators of the lower limb; however, recent advances in CT angiography have allowed researchers to accurately describe the cutaneous perforators and their route, diameter, and distance from important anatomic landmarks. All three major arteries of the distal leg have consistent clusters of perforators, popularizing their use for local soft-tissue coverage as perforator-based propeller flaps, which are island flaps. This video describes a propeller flap created with the use of a perforator of the posterior tibial artery. Several technical points for this flap reconstruction are demonstrated. The first pearl for a successful flap is to localize the dominant perforator via preoperative ultrasonography. The video demonstrates how to raise the flap, how to avoid kinking or strangulation of the pedicle, and how to perform the set-in. Compared with free flap reconstruction, propeller flap reconstruction decreases surgical time and affords better tissue color and thickness matching.

Results for "Foot and Ankle"

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