Abstract
Background Technical advancements and increasing experience in the management of soft tissue
defects in lower extremities have led to the evolution of decisional reconstructive
algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to
be useful methods of reconstruction for lower extremities defects, offering alternative
reconstructive tools. We present a case series of PPFs and FFs for reconstruction
of lower limbs defects, analyzing and comparing treatment and outcomes.
Methods Through a retrospective analysis, we report our experience in performing PPFs or
FFs for reconstruction of soft tissue defects of the lower extremities, in patients
admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery,
University of Palermo. In these patients, we evaluated location and causes of defects,
types of flaps used, recipient vessels, complications, time to healing, and aesthetic
outcome.
Results A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision
surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four).
Recovery time and hospitalization period were eventually shorter in patients with
FFs, due to lower rate of complications and revision surgery.
Conclusion In the past years, our indications for reconstruction with PPFs in the lower limb
have become more restricted, while we favor reconstruction with FFs. Recommendations
are provided to orient surgical treatment in small, medium, and large lower limb defects.
Keywords
lower limb reconstruction - propeller perforator flap - free flap
