Application of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

RAN Xiaoye , LIU Yuanbo , YANG Ruomeng ,  ZANG Mengqing

Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China;

Corresponding author：

ZANG Mengqing, Email: zangmengqing@sina.com

Keywords：

Soft tissue defect of distal lower extremity; perforator flap; propeller flap; flap sequential transfer technique; donor site repair

DOI：

10.7507/1002-1892.202111047

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Objective To explore the feasibility and effectiveness of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity. Methods Between July 2015 and July 2021, 10 patients with soft tissue defect of distal lower extremity were treated with perforator propeller flap sequential transfer technique. There were 8 males and 2 females, with a median age of 47 years (range, 6-71 years). The etiologies included malignant tumor in 5 cases, trauma in 3 cases, postburn scar contracture in 1 case, and diabetic foot ulcer in 1 case. The defects were located at the pretibial area in 1 case, the distal lower extremity and Achilles tendon in 3 cases, the dorsum of foot and lateral malleolar area in 4 cases, the heel in 1 case, and the plantar foot in 1 case. The size of the defect ranged from 5 cm×3 cm to 8 cm×8 cm. Peroneal artery perforator propellor flaps (the 1st flap) in size of 14 cm×4 cm to 29 cm×8 cm were used to repair the defects of distal lower extremity. The donor site defects were repaired with the other perforator propeller flaps (the 2nd flap) in size of 7 cm×3 cm to 19 cm×7 cm. The donor site of the 2nd flap was directly closed. Results All the operations were successfully completed and all of the 2nd flaps were elevated within 1 hour. Eight the 1st flaps survived completely; 2 had venous congestion. Among the 2 patients with venous congestion, 1 had necrosis of the distal end of the flap, and the secondary wound was repaired by skin grafting; 1 recovered spontaneously after 7 days. The 2nd flaps totally survived. No complication such as hematoma or infection occurred. Primary closure was achieved in all the recipient and donor sites. All patients were followed up 2-39 months, with a median of 15.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. The normal contour of the leg was preserved. During follow-up, no recurrence of malignance or ulcer was observed. The scar contracture was completely released. All patients were satisfied with the reconstructive outcomes. Conclusion The application of the perforator propeller flap sequential transfer technique can improve the repair ability of the lower extremity perforator propeller flap while ensuring the first-stage closure of the donor site, thereby improving the effectiveness.

Citation： RAN Xiaoye, LIU Yuanbo, YANG Ruomeng, ZANG Mengqing. Application of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 451-455. doi: 10.7507/1002-1892.202111047 Copy

1.	Georgescu AV. Propeller perforator flaps in distal lower leg: evolution and clinical applications. Arch Plast Surg, 2012, 39(2): 94-105.
2.	Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: Identification of risk factors for complications. Plast Reconstr Surg, 2016, 137(1): 314-331.
3.	Low OW, Sebastin SJ, Cheah AEJ. A review of pedicled perforator flaps for reconstruction of the soft tissue defects of the leg and foot. Indian J Plast Surg, 2019, 52(1): 26-36.
4.	Aukerman W, Urias D, Winegardner B, et al. A propeller perforator flap in the distal lower extremity: An alternative to free flap coverage near the ankle. Cureus, 2021, 13(6): e15476. doi: 10.5999/aps.2012.39.2.94.
5.	Lu TC, Lin CH, Lin CH, et al. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg, 2011, 64(3): 386-393.
6.	John JR, Tripathy S, Sharma RK, et al. Peroneal artery perforator-based flaps for reconstruction of middle and lower third post-traumatic defects of the leg. ANZ J Surg, 2015, 85(11): 869-872.
7.	Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
8.	Sharma M, Balasubramanian D, Thankappan K, et al. Propeller flaps in the closure of free fibula flap donor site skin defects. Ann Plast Surg, 2013, 71(1): 76-79.
9.	Hallock GG. Tissue expansion techniques to minimize morbidity of the anterolateral thigh perforator flap donor site. J Reconstr Microsurg, 2013, 29(9): 565-570.
10.	Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
11.	Elliot D, Bardsley AF, Batchelor AG, et al. Direct closure of the radial forearm flap donor defect. Br J Plast Surg, 1988, 41(4): 358-360.
12.	滕云升, 梁高峰, 文波, 等. 股前穿支接力皮瓣修复游离股前外侧皮瓣供区创面. 中华显微外科杂志, 2017, 40(2): 126-129.
13.	Iida T, Yoshimatsu H, Koshima I. Reconstruction of anterolateral thigh defects using perforator-based propeller flaps. Ann Plast Surg, 2017, 79(4): 385-389.
14.	Hudson CS, Huang AT. Perforator-based propeller flaps for reconstruction of massive anterolateral thigh donor site wounds. Head Neck, 2020, 42(12): E49-E52.
15.	Pagliara D, Mangialardi ML, Vitagliano S, et al. Improving outcomes in anterolateral thigh flap donor-site reconstruction using propeller flaps: A retrospective comparative study with skin grafting. J Reconstr Microsurg, 2021, 37(5): 436-444.
16.	Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
17.	Lee JT, Chen PR, Hsu H, et al. The proximal lateral lower leg perforator flap revisited: anatomical study and clinical applications. Microsurgery, 2015, 35(2): 115-122.
18.	Shimizu F, Kato A, Sato H, et al. Sural perforator flap: assessment of the posterior calf region as donor site for a free fasciocutaneous flap. Microsurgery, 2009, 29(4): 253-258.
19.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
20.	Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6): 672-678.
21.	D’Arpa S, Cordova A, Pignatti M, et al. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg, 2011, 128(4): 892-906.

1. Georgescu AV. Propeller perforator flaps in distal lower leg: evolution and clinical applications. Arch Plast Surg, 2012, 39(2): 94-105.
2. Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: Identification of risk factors for complications. Plast Reconstr Surg, 2016, 137(1): 314-331.
3. Low OW, Sebastin SJ, Cheah AEJ. A review of pedicled perforator flaps for reconstruction of the soft tissue defects of the leg and foot. Indian J Plast Surg, 2019, 52(1): 26-36.
4. Aukerman W, Urias D, Winegardner B, et al. A propeller perforator flap in the distal lower extremity: An alternative to free flap coverage near the ankle. Cureus, 2021, 13(6): e15476. doi: 10.5999/aps.2012.39.2.94.
5. Lu TC, Lin CH, Lin CH, et al. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg, 2011, 64(3): 386-393.
6. John JR, Tripathy S, Sharma RK, et al. Peroneal artery perforator-based flaps for reconstruction of middle and lower third post-traumatic defects of the leg. ANZ J Surg, 2015, 85(11): 869-872.
7. Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
8. Sharma M, Balasubramanian D, Thankappan K, et al. Propeller flaps in the closure of free fibula flap donor site skin defects. Ann Plast Surg, 2013, 71(1): 76-79.
9. Hallock GG. Tissue expansion techniques to minimize morbidity of the anterolateral thigh perforator flap donor site. J Reconstr Microsurg, 2013, 29(9): 565-570.
10. Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The Kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
11. Elliot D, Bardsley AF, Batchelor AG, et al. Direct closure of the radial forearm flap donor defect. Br J Plast Surg, 1988, 41(4): 358-360.
12. 滕云升, 梁高峰, 文波, 等. 股前穿支接力皮瓣修复游离股前外侧皮瓣供区创面. 中华显微外科杂志, 2017, 40(2): 126-129.
13. Iida T, Yoshimatsu H, Koshima I. Reconstruction of anterolateral thigh defects using perforator-based propeller flaps. Ann Plast Surg, 2017, 79(4): 385-389.
14. Hudson CS, Huang AT. Perforator-based propeller flaps for reconstruction of massive anterolateral thigh donor site wounds. Head Neck, 2020, 42(12): E49-E52.
15. Pagliara D, Mangialardi ML, Vitagliano S, et al. Improving outcomes in anterolateral thigh flap donor-site reconstruction using propeller flaps: A retrospective comparative study with skin grafting. J Reconstr Microsurg, 2021, 37(5): 436-444.
16. Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg, 2004, 114(4): 910-916.
17. Lee JT, Chen PR, Hsu H, et al. The proximal lateral lower leg perforator flap revisited: anatomical study and clinical applications. Microsurgery, 2015, 35(2): 115-122.
18. Shimizu F, Kato A, Sato H, et al. Sural perforator flap: assessment of the posterior calf region as donor site for a free fasciocutaneous flap. Microsurgery, 2009, 29(4): 253-258.
19. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
20. Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6): 672-678.
21. D’Arpa S, Cordova A, Pignatti M, et al. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg, 2011, 128(4): 892-906.

Chinese Journal of Reparative and Reconstructive Surgery

Application of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity

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