Objective: Operative technique of propeller flap reconstruction of soft tissue defects in the distal lower extremity. Soft tissue reconstruction of the distal third of the lower extremity with local, reliable perforator flaps avoiding free tissue transfer.
Indications: Complex wounds (maximum width of 6 cm) of the distal lower extremity with exposed bones, joints, tendons, and neurovascular structures.
Contraindications: Arterial vascular disease (stage III or IV), diabetes mellitus, postthrombotic syndrome, venous ulcers, chronic lymphedema, contusion of adjacent soft tissue, previous radiation, and lack of perforators
Surgical technique: The perforator represents the pivot point around which rotation of up to 180º of the subfascially harvested flap allows closure of the defect. The proximal donor site can be closed primarily up to a width of 6 cm.
Postoperative management: Strict elevation of the extremity for 5 days, then flap conditioning.
Results: This technique was used for soft tissue reconstruction in 17 patients. In one patient with diabetes, complete flap necrosis occurred, requiring amputation of the extremity. One case of epidermolysis healed without further surgery.