Reconstruction of complex lower limb soft tissue injury following trauma can often be challenging owing to the combination of limited suitable local tissue and bony injuries. The evolution of locoregional flap reconstruction by incorporating intramuscular dissection of perforators introduces the propeller perforator flaps (PPF) to the reconstructive algorithm. PPFs provides additional pedicle length, allowing for axial rotation of locoregional tissue, which is a valuable in replacing ‘like with like’ tissue for lower limb reconstruction.1 Compared to free flaps (FF) reconstruction, PPFs are often considered to be a less invasive, yet effective and elegant approach for reconstructing lower limb defect of average size.2 We present a retrospective analysis comparing treatment and outcomes of PPFs and FFs reconstruction in traumatic lower limb defects.
A single centre retrospective analysis on traumatic lower limb soft tissue reconstruction was undertaken. Patient demographics, pre-operative, operative, and post-operative findings were compared across the two groups.
Over a six year period, six patients requiring PPF and seven patients requiring FF were included. The operative duration were shorter for PPF reconstruction with a median (IQR) time of 232 (229-274) mins when compared to FF reconstruction (876 (768-931) mins). Patients with FF reconstruction had a shorter post-operative stay when compared to PFF reconstruction (15 (11-21) days vs. 21 (13-22) days). Furthermore, PFF reconstruction required more leech therapy post-operatively (7.5 (6-11) vs. 0 (0-0) days) and had a higher rate of partial necrosis (50% vs. 14%). However, the rate of wound dehiscence in PPF reconstruction was lower when compared to FF reconstruction (16.7% vs. 28.6%). There were no cases of coverage failure in either group.
PPFs for lower limb soft tissue reconstruction is a valuable option, particularly for patients with significant co-morbidities and/or with diseased or injured recipient vessels and average sized defect.