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wjps 2019, 8(1): 3-11 Back to browse issues page
The Clinical Outcome of Perforator Based Sural Artery and Propeller Flaps in Reconstruction of Soft Tissue of Extremities
Subha Dhua , Sankhe Manashree, Bal Gangadhar Tilak
Associate Professor
Abstract:   (824 Views)
The reconstructive options for the soft tissues in extremities present serious challenges due to thin non-expendable soft tissues and predisposition to massive edema formation, thus frequently requiring flap cover. This study was undertaken to assess the outcome of a modified version of the sural artery flap with that of propeller perforator flaps for the reconstruction of lower extremities, particularly the heel defects. 
This prospective study was conducted on 40 consecutive patients, of which 20 treated with sural artery flap and another 20 with perforator based propeller flap cover for soft tissue reconstruction in extremities based on predefined inclusion criteria. The clinical outcome of the flap was assessed after three months.
Inclusion of the posterior tibial perforators (along with the sural artery and the peroneal artery) was shown to enhance the flap territory. The raising of the flap was quick with minimal blood loss and the modified flap had a wide arc of rotation for reconstruction of the heel defects. The younger patients regained sensation on the flap earlier, while the durability of the fasciocutaneous flap was excellent in the heel weight bearing areas. The success rate was 95% flap take. 
Careful selection of the perforator and optimal designing of the flap result in favorable outcomes with the use of local perforator flaps for reconstruction in extremities. It provides predictable clinical outcomes with minimal donor site morbidity, is cost-effective, relatively easy technique and requires no special microsurgical setup or instruments. 
Keywords: Propeller flap, Subcutaneous pedicled propeller flap, Perforator pedicled propeller flap
Full-Text [PDF 1405 kb]   (454 Downloads)    
Type of Study: Original Article | Subject: Special
Received: 2018/09/26 | Accepted: 2019/03/13 | Published: 2019/03/13
1. Bennett JP. Aspects of the history of plastic surgery since the 16th century. J R Soc Med 1983;76:152-6. doi: 10.1177/014107688307600214. [DOI:10.1177/014107688307600214]
2. Lascaratos J, Cohen M, Voros D. Plastic surgery of the face in Byzantium in the fourth century. Plast Reconstr Surg 1998;102:1274-80. doi: 10.1097/00006534-199809040-00061. [DOI:10.1097/00006534-199809040-00061]
3. O'Brien BM, Shanmugan N. Experimental transfer of composite free flaps with microvascular anastomoses. Aust N Z J Surg 1973;43:285-8. doi: 10.1111/j.1445-2197.1973.tb05706.x. [DOI:10.1111/j.1445-2197.1973.tb05706.x]
4. Taylor GI, Corlett RJ, Caddy CM, Zelt RG. An anatomic review of the delay phenomenon: II. Clinical applications. Plast Reconstr Surg 1992;89:408-16; discussion 17-8. doi: 10.1097/00006534-199203000-00002. [DOI:10.1097/00006534-199203000-00002]
5. Ohmori K, Harii K. Free dorsalis pedis sensory flap to the hand, with microneurovascular anastomoses. Plast Reconstr Surg 1976;58:546-54. doi: 10.1097/00006534-197611000-00003. [DOI:10.1097/00006534-197611000-00003]
6. Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 1981;34:215-20. 10.1016/s0007-1226(81)80097-5. doi: 10.1016/S0007-1226(81)80097-5. [DOI:10.1016/S0007-1226(81)80097-5]
7. Manchot, C. The cutaneous arteries of the human body. New York: Springer-Verlog; 1983. p. 112. doi: 10.1007/978-1-4613-8221-8. [DOI:10.1007/978-1-4613-8221-8]
8. Salmon M, Taylor GI, Razaboni RM. Anatomic Studies [including] Book 1, Arteries of the Muscles of the Extremities and the Trunk [and] Book 2, Arterial Anastomotic Pathways of the Extremities. Sant Louis MO: Quality Medical Publishing; 1994. p. 204.
9. Wu WC, Chang YP, So YC, Yip SF, Lam YL. The anatomic basis and clinical applications of flaps based on the posterior tibial vessels. Br J Plast Surg 1993;46:470-9. doi: 10.1016/0007-1226(93)90220-6. [DOI:10.1016/0007-1226(93)90220-6]
10. Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992;89:1115-21. doi: 10.1097/00006534-199206000-00018. [DOI:10.1097/00006534-199206000-00018]
11. Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg 1994;93:1012-20. doi: /10.1097/00006534-199404001-00016.
12. Hyakusoku H, Tonegawa H, Fumiiri M. Heel coverage with a T-shaped distally based sural island fasciocutaneous flap. Plast Reconstr Surg 1994;93:872-6. doi: 10.1097/00006534-199404000-00036. [DOI:10.1097/00006534-199404000-00036]
13. Oberlin C, Azoulay B, Bhatia A. The posterolateral malleolar flap of the ankle: a distally based sural neurocutaneous flap--report of 14 cases. Plast Reconstr Surg 1995;96:400-5; discussion 6-7. doi: 10.1097/00006534-199508000-00021. [DOI:10.1097/00006534-199508000-00021]
14. Rajacic N, Darweesh M, Jayakrishnan K, Gang RK, Jojic S. The distally based superficial sural flap for reconstruction of the lower leg and foot. Br J Plast Surg 1996;49:383-9. doi: 10.1016/s0007-1226(96)90007-7. [DOI:10.1016/S0007-1226(96)90007-7]
15. Imanishi N, Nakajima H, Fukuzumi S, Aiso S. Venous drainage of the distally based lesser saphenous-sural veno-neuroadipofascial pedicled fasciocutaneous flap: a radiographic perfusion study. Plast Reconstr Surg 1999;103:494-8. doi: 10.1097/00006534-199902000-00020. [DOI:10.1097/00006534-199902000-00020]
16. Barclay TL, Cardoso E, Sharpe DT, Crockett DJ. Repair of lower leg injuries with fascio-cutaneous flaps. Br J Plast Surg 1982;35:127-32. doi: 10.1016/0007-1226(82)90148-5. [DOI:10.1016/0007-1226(82)90148-5]
17. Li L, Li Z, Li X. [The reverse-flow lateral sural cutaneous artery island flap: anatomical study]. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1995;11:23-5.
18. Zang Z. Postero lateral and postero medial distally based island fasciocutaneous flaps for lower one-third of leg defect. 1997;18:35-37. Chinese.
19. Le Fourn B, Caye N, Pannier M. Distally based sural fasciomuscular flap: anatomic study and application for filling leg or foot defects. Plast Reconstr Surg 2001;107:67-72doi: 10.1097/00006534-200101000-00011. [DOI:10.1097/00006534-200101000-00011]
20. Al-Qattan MM. A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: inclusion of a gastrocnemius muscle "cuff" around the sural pedicle. Ann Plast Surg 2001;47:269-74, discussion 74-8. doi: 10.1097/00000637-200109000-00009. [DOI:10.1097/00000637-200109000-00009]
21. Mueller JE, Ilchmann T, Lowatscheff T. The musculocutaneous sural artery flap for soft-tissue coverage after calcaneal fracture. Arch Orthop Trauma Surg. 2001;121:350-2. doi: 10.1007/s004020000238. PubMed PMID: 11482470. [DOI:10.1007/s004020000238]
22. Thatte RL. Random-pattern de-epithelialised "turn-over" flaps to replace skin loss in the upper third of the leg. Br J Plast Surg 1981;34:312-4. doi: 10.1016/0007-1226(81)90018-7. [DOI:10.1016/0007-1226(81)90018-7]
23. Amarante J, Costa H, Reis J, Soares R. A new distally based fasciocutaneous flap of the leg. Br J Plast Surg 1986;39:338-40. doi: 10.1016/0007-1226(86)90043-3. [DOI:10.1016/0007-1226(86)90043-3]
24. Carriquiry CE. Heel coverage with a deepithelialized distally based fasciocutaneous flap. Plast Reconstr Surg 1990;85:116-9. do: 10.1097/00006534-199001000-00022.
25. Cormack GC, Lamberty BG. The arterial anatomy of skin flaps. 2th ed. London: Churchill Livingstone; 1994. p. 395.
26. Hasegawa M, Torii S, Katoh H, Esaki S. The distally based superficial sural artery flap. Plast Reconstr Surg 1994;93:1012-20 doi: 10.1097/00006534-199404001-00016. [DOI:10.1097/00006534-199404001-00016]
27. Coert JH, Dellon AL. Clinical implications of the surgical anatomy of the sural nerve. Plast Reconstr Surg 1994;94:850-5. doi: 10.1097/00006534-199411000-00016. [DOI:10.1097/00006534-199411000-00016]
28. Jeng SF, Wei FC. Distally based sural island flap for foot and ankle reconstruction. Plast Reconstr Surg 1997;99:744-50. doi: 10.1097/00006534-199703000-00022. [DOI:10.1097/00006534-199703000-00022]
29. Mukherjee MK, Alam Parwaz M, Chakravarty B, Langer V. Perforator flap: A novel method for providing skin cover to lower limb defects. Med J Armed Forces India 2012;68:328-34. doi: 10.1016/j.mjafi.2012.03.003. [DOI:10.1016/j.mjafi.2012.03.003]
30. Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009;124:1529-44. doi: 10.1097/PRS.0b013e3181b98a6c. [DOI:10.1097/PRS.0b013e3181b98a6c]
31. Ademola SA, Michael AI, Oladeji FJ, Mbaya KM, Oyewole O. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile Alternative when Reverse Sural Artery Flap is Not Feasible. J Surg Tech Case Rep 2015;7:23-7. doi: 10.4103/2006-8808.184943. [DOI:10.4103/2006-8808.184943]
32. Panse N, Sahasrabudhe P. Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction! Indian J Plast Surg 2014;47:77-84. doi: 10.4103/0970-0358.129628. [DOI:10.4103/0970-0358.129628]
33. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42:645-8. doi: 10.1016/0007-1226(89)90075-1. [DOI:10.1016/0007-1226(89)90075-1]
34. Lazzeri D, Huemer GM, Nicoli F, Larcher L, Dashti T, Grassetti L, Li Q, Zhang Y, Spinelli G, Agostini T. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: a systematic review. Arch Plast Surg 2013;40:44-50. doi: 10.5999/aps.2013.40.1.44. [DOI:10.5999/aps.2013.40.1.44]
35. Masia J, Moscatiello F, Pons G, Fernandez M, Lopez S, Serret P. Our experience in lower limb reconstruction with perforator flaps. Ann Plast Surg 2007;58:507-12. doi: 10.1097/01.sap.0000239841.47088.a5. [DOI:10.1097/01.sap.0000239841.47088.a5]
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Dhua S, Manashree S, Tilak B G. The Clinical Outcome of Perforator Based Sural Artery and Propeller Flaps in Reconstruction of Soft Tissue of Extremities. wjps. 2019; 8 (1) :3-11
URL: http://wjps.ir/article-1-446-en.html

Volume 8, Issue 1 (1-2019) Back to browse issues page
مجله جهانی جراحی پلاستیک World Journal of Plastic Surgery
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