The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction: Risk Factors, Pitfalls, and Recommendations.

Lese, Ioana; Grobbelaar, Adriaan O.; Sabau, Dan; Georgescu, Alexandru V; Constantinescu, Mihai A.; Olariu, Radu (2020). The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction: Risk Factors, Pitfalls, and Recommendations. Journal of bone and joint surgery - American volume, 102(6), pp. 510-518. Journal of Bone & Joint Surgery Inc. 10.2106/JBJS.19.00648

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BACKGROUND Defects in the distal third of the leg are difficult to cover and often require free tissue transfer, even for defects of limited sizes. Propeller flaps have been designed specifically as an alternative to free tissue transfer but at times have been associated with unacceptably high complication rates. We therefore aimed to prospectively assess our own institutional experience with this technique and to define its role in lower-limb reconstruction. METHODS All patients who had been managed with reconstruction of the distal part of the leg with a propeller flap between 2014 and 2017 were included in the study. Demographic, clinical, and follow-up data on the patients and surgical procedures were recorded with special focus on the complication profile. RESULTS Twenty-six patients underwent propeller flap reconstruction of the distal part of the leg: 12 flaps were based on the posterior tibial artery, and 14 were based on the peroneal artery. Postoperative complications developed in association with 1 of the 12 flaps based on the posterior tibial artery, compared with 8 of the 14 flaps based on the peroneal artery (p = 0.015). Moreover, the presence of a higher Charlson comorbidity index (≥2) was strongly associated with the development of postoperative complications (p < 0.001). CONCLUSIONS Propeller flaps are a reliable option for traumatic reconstruction in carefully selected patients with lower-limb defects. In our experience, the rate of complications was higher for propeller flaps based on the peroneal artery and for patients with a Charlson comorbidity index of ≥2, whereas posterior tibial artery-based propeller flap reconstruction was a reliable surgical option for patients with a small defect in the distal third of the lower limb. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Plastic, Reconstructive and Aesthetic Surgery

UniBE Contributor:

Lese, Ioana; Grobbelaar, Adriaan Ockert; Constantinescu, Mihai Adrian and Olariu, Radu

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0021-9355

Publisher:

Journal of Bone & Joint Surgery Inc.

Language:

English

Submitter:

Veronika Picha

Date Deposited:

16 Dec 2019 16:28

Last Modified:

22 Mar 2020 01:31

Publisher DOI:

10.2106/JBJS.19.00648

PubMed ID:

31804239

BORIS DOI:

10.7892/boris.136338

URI:

https://boris.unibe.ch/id/eprint/136338

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