Experience with Local Perforator Flaps in Lower Limb Reconstruction Using the “Propeller Principle”

The propeller flap, an islanded 180° rotation single perforator flap, is a good method to transfer tissue in the lower limb. It provides similar skin texture and color characteristics, with good blood perfusion, without vascular sacrifice, and without any muscular function alteration. Local perforator flaps could be considered as microsurgical flaps without microvascular anastomosis, because the same surgical dissection technique is required.

A retrospective study reviewed the application of the propeller principle with local perforator flaps for lower limb reconstruction during 2001–2004. Thirty-six flaps were utilized for lower limb reconstruction: subacute or chronic open fractures (36%), postoncology surgery (33%), and subacute or chronic soft tissue injury (31%). The single perforator flaps were based on: 12 posterior tibial, 10 peroneal, 6 descending genicular, 4 ALTF, and 4 superior gluteal system flaps.

There was partial flap loss (< 20%) in 3 patients, 1 partial loss (> 20%), and 1 complete flap loss.

The propeller principle in lower limb perforator flaps is a reliable method for covering small- and medium-sized defects. The keys to the procedure are a good design, meticulous dissection, and an understanding of the angiosomes and the vascular anatomy of the lower limb.