Single perforator greater saphenous neuro‐veno‐fasciocutaneous propeller flaps for lower extremity reconstructions

• Published in: ANZ journal of surgery Vol. 87; no. 7-8; pp. E40 - E45
• Main Authors: Zhong, Wanrun, Lu, Shengdi, Wang, Chunyang, Wen, Gen, Han, Pei, Chai, Yimin
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.07.2017
• Subjects: Adult; Color matching; Defects; Feet; Female; Grafts; Humans; Infections; Leg; Leg Injuries - surgery; lower extremities; Lower Extremity - surgery; Male; Medical personnel; Men; Middle Aged; perforator flap; Perforator Flap - blood supply; Perforator Flap - innervation; Reconstructive Surgical Procedures - methods; saphenous flap; saphenous nerve; Saphenous Vein - surgery; Skin; Skin & tissue grafts; Skin grafts; Twisting; Young Adult; perforator flap; saphenous flap; saphenous nerve; lower extremities
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.13065

Background The lack of soft tissue that is available for medial leg and foot defect reconstructions presents a challenge for plastic surgeons. The saphenous neurofasciocutaneous perforator flap application presents an effective alternative to local flap transfers. However, the venous flow and pedicle twisting problems are still disputed. Here, we present our experiences with modified cutaneous pedicles with a single perforator pedicle, which improves the venous flow and the pedicle twisting problem. Methods This study was conducted from June 2007 through September 2011, and a total of 15 patients with lower medial leg and foot defects were included. There were 11 men and four women. An asymmetric ‘propeller’ flap was planned around a perforator that was adjacent to the defects, which was preoperatively confirmed by Doppler. The perforator was sufficiently dissociated to allow for the flap to be turned towards the defects. We preserved some distal skin and subcutaneous tissue from the short side of the ‘propeller’ to cover some donor site regions, and other regions were covered with split thickness skin grafts. The follow‐up period ranged from 3 to 12 months. Results An infection occurred in one case. Partial flap necrosis was noted in two cases. The other 12 flaps completely survived and matched the recipient sites with regard to colour, texture and thickness. Conclusion The single perforator greater saphenous neuro‐veno‐fasciocutaneous propeller flap is an effective solution for medial leg and foot defects, and it has a large rotation arc and a satisfactory aesthetic result.