Ergonomics and Biogeometry of Perforator/Propeller Flaps in the Lower Limb Reconstruction

Reconstruction of lower limb defects is quite challenging in terms of scarcity of locally available flaps, poor wound healing and need for prolonged immobilization. Normally also there is decreased blood supply in the anterolateral aspect of leg and foot. Leg and foot is like a peninsula with no distal tissues available for proximal reconstruction. Also there is a paucity of loose tissue in leg and foot hence to reconstruct with a flap with least donor morbidity requires more expertise from the reconstructive surgeon. Local fasciocutaneous flaps, various muscle/ musculocutaneous flaps and free flaps were widely used. The era of perforator flaps began in 1989 describing their application and the great potential in harvesting of perforator flaps for lower limb defects.1,2 Perforator flap is defined as cutaneous paddle harvested on a direct cutaneous or septofasciocutaneous/musculocutaneous perforator which are rendered direct by periperforator dissection. Propeller flaps have two unequal blades (skin paddles) centered on the perforator and rotated on the single best perforator to the primary defect and the secondary blade potentially filling the secondary defect reducing tension on the perforator pedicle.3-5 Perforator/propeller flaps enjoys a homogenized high vascularity. This is due to wide undermining and staging of the flap during the harvest itself leading to sympathectomy and contributing to increased blood supply. It has got the benefits of the musculocutaneous flaps minus the muscle. All steal phenonmenon due to undesired components like muscle, fascia, and fat is eliminated. This also contributes to the increased blood supply. Propeller flaps decrease the morbidity of the donor site by providing the small blade of tissue for partial reconstruction of the secondary defect. Also the standing cones and the reclining cones of the wide closing angles and unequal side respectively are not encountered in propeller flap which increases the aesthesis of the local reconstruction. It has all the benefits of local tissue with good color, thickness and texture match.6,7 This study assessed the ergonomics and biogeometry of perforator/propeller flaps in the lower limb reconstruction. This prospective study was conducted between January 2009 and December 2013 in the Department Of Plastic Surgery of our institution. A total of 113 patients were included in this study. Only chronic posttraumatic and post excisional defects were included. Perforators flaps based on lateral calcaneal artery, superficial peroneal nerve artery, arcuate artery, anterior tibial artery, posterior tibial artery, ponten perforator, anterior recurrent introsseous artery, descending branch of ramus perforans, Department of Plastic and Reconstructive Surgery, Skims, Srinagar, India