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RESEARCH PRODUCT
The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction: Risk Factors, Pitfalls, and Recommendations.
Radu OlariuMihai A. ConstantinescuAdriaan O. GrobbelaarAlexandru Valentin GeorgescuDan SabauIoana Lesesubject
AdultMalemedicine.medical_specialtySoft Tissue InjuriesAdolescent030230 surgeryLower limb03 medical and health sciencesYoung Adult0302 clinical medicinePostoperative ComplicationsRisk Factorsmedicine.arteryMedicineHumansOrthopedics and Sports Medicine610 Medicine & healthAgedRetrospective StudiesPeroneal ArteryAged 80 and overbusiness.industryPropellerRetrospective cohort studyGeneral MedicineMiddle AgedPlastic Surgery ProceduresSurgeryTissue transferPosterior tibial artery030220 oncology & carcinogenesisCharlson comorbidity indexSurgeryFemalebusinessComplicationPerforator FlapFollow-Up StudiesLeg Injuriesdescription
BACKGROUND Defects in the distal third of the leg are difficult to cover and often require free tissue transfer, even for defects of limited sizes. Propeller flaps have been designed specifically as an alternative to free tissue transfer but at times have been associated with unacceptably high complication rates. We therefore aimed to prospectively assess our own institutional experience with this technique and to define its role in lower-limb reconstruction. METHODS All patients who had been managed with reconstruction of the distal part of the leg with a propeller flap between 2014 and 2017 were included in the study. Demographic, clinical, and follow-up data on the patients and surgical procedures were recorded with special focus on the complication profile. RESULTS Twenty-six patients underwent propeller flap reconstruction of the distal part of the leg: 12 flaps were based on the posterior tibial artery, and 14 were based on the peroneal artery. Postoperative complications developed in association with 1 of the 12 flaps based on the posterior tibial artery, compared with 8 of the 14 flaps based on the peroneal artery (p = 0.015). Moreover, the presence of a higher Charlson comorbidity index (≥2) was strongly associated with the development of postoperative complications (p < 0.001). CONCLUSIONS Propeller flaps are a reliable option for traumatic reconstruction in carefully selected patients with lower-limb defects. In our experience, the rate of complications was higher for propeller flaps based on the peroneal artery and for patients with a Charlson comorbidity index of ≥2, whereas posterior tibial artery-based propeller flap reconstruction was a reliable surgical option for patients with a small defect in the distal third of the lower limb. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-12-04 | The Journal of bone and joint surgery. American volume |