Background
It is a challenge to achieve a reliable flap cover over the exposed posterior calcaneum at the back of the heal following trauma or infection. Various techniques such as sural flaps and cross leg flaps have been used historically which resulted in a quite high morbidity, high scar burden and patient dissatisfaction with suboptimal clinical outcomes. Microvascular free tissue transfer is a major surgical procedure with prolonged general anesthesia some patients are not good candidates.
We present a case series of the newer technique of inferior tibial perforator based propeller flaps. This is a constant perforator about 5cms above the medial malleolus and the Perferosome can be used as a propeller flap.
Methodology/Operative Technique
Following are two cases performed to cover posterior ankle wounds. Both were elderly ladies over 70 years old with hypertension and diabetes mellitus who were not candidates for long surgery under GA.
I surface marked the lower tibial perforator using a handheld doppler about 5 cm above the medial malleolus. Strong doppler signal was demonstrated before the flap is designed.
Exploratory incision revealed good size perforating vessels & facio-cutaneous flap was raised sub facially preserving paratenon of the Achilles tendon. Meticulous dissection was done around the perforator which was released from all deep fascial structures.
Flap was rotated in propeller fashion and inserted to the defect without tension. Secondary defect was Skin grafted. For the first 3 weeks we kept the ankle planta flexed with a POP front slab
Results
Our flaps survived well, and wounds healed within one month time. Patients could weight bear in 2 month time.
Discussion
This perforator was a constant one with a good caliber artery and vein on both occasions.
Conclusion
Inferior tibial perforator Propeller flap is a reliable flap option to reconstruct posterior ankle / Calcaneal tissue defects.