Objective To explore the feasibility and effectiveness of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity. Methods Between July 2015 and July 2021, 10 patients with soft tissue defect of distal lower extremity were treated with perforator propeller flap sequential transfer technique. There were 8 males and 2 females, with a median age of 47 years (range, 6-71 years). The etiologies included malignant tumor in 5 cases, trauma in 3 cases, postburn scar contracture in 1 case, and diabetic foot ulcer in 1 case. The defects were located at the pretibial area in 1 case, the distal lower extremity and Achilles tendon in 3 cases, the dorsum of foot and lateral malleolar area in 4 cases, the heel in 1 case, and the plantar foot in 1 case. The size of the defect ranged from 5 cm×3 cm to 8 cm×8 cm. Peroneal artery perforator propellor flaps (the 1st flap) in size of 14 cm×4 cm to 29 cm×8 cm were used to repair the defects of distal lower extremity. The donor site defects were repaired with the other perforator propeller flaps (the 2nd flap) in size of 7 cm×3 cm to 19 cm×7 cm. The donor site of the 2nd flap was directly closed. ResultsAll the operations were successfully completed and all of the 2nd flaps were elevated within 1 hour. Eight the 1st flaps survived completely; 2 had venous congestion. Among the 2 patients with venous congestion, 1 had necrosis of the distal end of the flap, and the secondary wound was repaired by skin grafting; 1 recovered spontaneously after 7 days. The 2nd flaps totally survived. No complication such as hematoma or infection occurred. Primary closure was achieved in all the recipient and donor sites. All patients were followed up 2-39 months, with a median of 15.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. The normal contour of the leg was preserved. During follow-up, no recurrence of malignance or ulcer was observed. The scar contracture was completely released. All patients were satisfied with the reconstructive outcomes. Conclusion The application of the perforator propeller flap sequential transfer technique can improve the repair ability of the lower extremity perforator propeller flap while ensuring the first-stage closure of the donor site, thereby improving the effectiveness.
Objective To explore the feasibility and effectiveness of using the superior lateral genicular artery (SLGA) perforator propeller flap to reconstruct soft-tissue defects around the knee joint. Methods Between October 2013 and May 2019, 10 patients underwent repairing of soft-tissue defects around the knee joint using the SLGA perforator propeller flap. There were 6 males and 4 males, with a median age of 34.5 years (range, 6-66 years). Etiologies included radical tumor resection in 4 cases, post-burn scar contracture in 3 cases, post-burn hypertrophic scar in 2 cases, and prothesis exposure after knee arthroplasty in 1 case. Defects located on the lateral knee in 6 cases, proximal lateral leg in 2 cases, popliteal fossa in 1 cases, and infrapatellar region in 1 case. The size of soft-tissue defects was from 6 cm×4 cm to 14 cm×8 cm. The extraction range of the flap was from 10.0 cm×5.5 cm to 23.0 cm×7.0 cm; the length of the perforator pedicle was 2.5-5.0 cm, with an average of 3.65 cm; the flaps were rotated 180°, the large paddle of the propeller flap was used to repair the defect, and the small paddle was used to assist the closure of donor site. Results Blister was observed in the distal 3-cm of one flap and the flap survived after conservative management. All the flaps survived, and the wounds in the donor and recipient areas healed by first intention. There was no vascular crisis, incision dehiscence, infection, or other complications. All 10 patients were followed up 4 to 48 months, with an average of 12.6 months. The color and texture of the flap were similar to those of the recipient area, and there was no need for secondary operation for degreasing and thinning. Scar contracture was corrected; no tumor recurrence was found in tumor patients; the artificial knee joint was preserved, the knee joint flexion and extension activities were good, and all the patient and family members were satisfied with the appearance and function of the lower limbs after operation. Conclusion The SLGA perforator propeller flap surgery is relatively simple without the need of microvascular anastomosis, has the minimal donor-site morbidities, and can provide a compound flap for the repairing of a complex wound. The SLGA perforator propeller flap is one of the optional methods to repair soft-tissue defects around the knee joint.