Simple or complex defects in the lower leg, and especially in its distal third, continue
to be a challenging task for reconstructive surgeons. A variety of flaps were used
in the attempt to achieve excellence in form and function. After a long evolution
of the reconstructive methods, including random pattern flaps, axial pattern flaps,
musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of
Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era
began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described
the first applications of such flaps. Perforator flaps, whether free or pedicled,
gained a high popularity due to their main advantages: decreasing donor-site morbidity
and improving aesthetic outcome. The use as local perforator flaps in lower leg was
possible due to a better understanding of the cutaneous circulation, leg vascular
anatomy, angiosome and perforasome concepts, as well as innovations in flaps design.
This review will describe the evolution, anatomy, flap design, and technique of the
main distally pedicled propeller perforator flaps used in the reconstruction of defects
in the distal third of the lower leg and foot.
Keywords
Soft tissue injuries - Leg - Surgical flaps
