Microscopic Retrograde Great Saphenous Vein Supercharge Anastomosis to Overcome Propeller Flap Congestion in Lower Limb Defect Reconstruction: A Case Report

Reconstruction of lower limb defects can be challenging, especially when local flaps are not feasible. While free flaps are an effective option, they are time-consuming and may not be suitable for inflamed areas. Perforator-based flaps, including propeller flaps, serve as viable alternatives to free flaps. However, venous congestion remains the most common complication associated with propeller flaps, and venous supercharging is a technique that can help mitigate this issue. This report presents a case of a 28-year-old patient with a severe knee injury who was treated using a propeller flap. The great saphenous vein was included in the flap and clipped proximally. After flap dissection, the flap was propelled to the defect, with the clipped end of the saphenous vein located at the proximal of lower limb. An anastomosis was performed between the proximally clipped end of the saphenous vein and the distal end of the saphenous vein at the proximal part of the lower limb to prevent venous congestion and ensure venous drainage in a retrograde direction (from proximal to distal). Propeller-based flaps are an excellent choice for reconstructing lower limb defects. Retrograde microscopic anastomosis of the great saphenous vein can effectively prevent venous congestion.