Perforator artery analysis and salvage procedure of propeller flaps on the reconstruciton of distal lower extremity

Reconstructive options for skin defects in the distal lower extremity are limited. Propeller flaps (PF) represent an important option due to their practicality and wide applicability. Planning the flap in a rational and practical manner facilitates reconstruction in this area. PF was performed in 52 patients with distal lower extremity soft tissue defects. The patients had an age range of 23 to 58 years, with a male preponderance (45 males and 7 female). The flap size ranged from 8 × 4 to 18 × 7 cm. This study was conducted retrospectively to examine the salvage procedure in cases of venous congestion, which is frequently encountered with PF. Total necrosis was not occured in any of the patients. Partial necrosis developed in three patient, accounting for 1/5 of the flap. Moderate venous congestion (MVC) occurred in 10 patients, all of whom received leech therapy. One patient developed an infection on postoperative day 4. Venous supercharging was performed in 23 patients during surgery. No complications occurred in 42 patients. In statistical analysis, increasing artery diameter significantly increases the frequency of supercharging (p = 0,001), and also increasing the degree of flap rotation significantly increases the risk of MVC (p = 0,001). In distal lower extremity tissue defects where the use of local flap is limited, PF can potentially become the first choice. Complications such as venous congestion, which most commonly occur with these flaps, can be readily addressed using salvage procedures such as leech therapy and venous supercharging.