Comparative Analysis of the Treatment of Skin Lesions of the Lower Limbs with Sural Flap versus Propeller Flap^[*]

Abstract

Objective The objective of the present study was to prospectively compare the sural and propeller flaps for soft-tissues coverage of the lower extremity. The following variables were evaluated: incidence of complete or partial flap loss and donor area morbidity (primary closure versus skin graft).

Methods Prospective and randomized analysis of data collected from all patients presenting with soft tissue defects of the lower third of the leg and heel treated with reverse sural or propeller flaps.

Results Twenty-four patients aged between 4 and 60 years old were evaluated between 2011 and 2017. Complete coverage was obtained in 22 of the 24 patients (91.6%). Two flaps failed (8.4%). The sural flap, being the most popular option, continues to represent a safe and versatile alternative for skin defects of the lower third of the leg and heel region. Likewise, the propeller flap was a comparable option to treat these challenging defects.

Conclusion Sural and propeller flaps are good options for soft tissues coverage of the lower extremity, with low complication rates (partial or total flap loss).

Keywords

perforator flap - surgical flaps - transplant donor site

• Referências

• 1 Zhang F, Lin S, Song Y, Zhang G, Zheng H. Distally based sural neuro-lesser saphenous veno-fasciocutaneous compound flap with a low rotation point: microdissection and clinical application. Ann Plast Surg 2009; 62 (04) 395-404
• 2 Aoki S, Tanuma K, Iwakiri I. et al. Clinical and vascular anatomical study of distally based sural flap. Ann Plast Surg 2008; 61 (01) 73-78
• 3 Jakubietz RG, Jakubietz MG, Gruenert JG, Kloss DF. The 180-degree perforator-based propeller flap for soft tissue coverage of the distal, lower extremity: a new method to achieve reliable coverage of the distal lower extremity with a local, fasciocutaneous perforator flap. Ann Plast Surg 2007; 59 (06) 667-671
• 4 Tos P, Innocenti M, Artiaco S. et al. Perforator-based propeller flaps treating loss of substance in the lower limb. J Orthop Traumatol 2011; 12 (02) 93-99
• 5 Noack N, Hartmann B, Küntscher MV, Ku MV. Measures to prevent complications of distally based neurovascular sural flaps. Ann Plast Surg 2006; 57 (01) 37-40
• 6 Moscatiello F, Masià J, Carrera A, Clavero JA, Larrañaga JR, Pons G. The ‘propeller’ distal anteromedial thigh perforator flap. Anatomic study and clinical applications. J Plast Reconstr Aesthet Surg 2007; 60 (12) 1323-1330
• 7 Costa-Ferreira A, Reis J, Pinho C, Martins A, Amarante J. The distally based island superficial sural artery flap: clinical experience with 36 flaps. Ann Plast Surg 2001; 46 (03) 308-313
• 8 Rajendra Prasad JS, Cunha-Gomes D, Chaudhari C, Bhathena HM, Desai S, Kavarana NM. The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous and muscle flaps: anatomical basis of a new concept. Br J Plast Surg 2002; 55 (03) 203-209
• 9 Murakami M, Hyakusoku H, Ogawa R. The multilobed propeller flap method. Plast Reconstr Surg 2005; 116 (02) 599-604
• 10 Lu TC, Lin CH, Lin CH, Lin YT, Chen RF, Wei FC. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011; 64 (03) 386-393
• 11 Pignatti M, Ogawa R, Hallock GG. et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg 2011; 127 (02) 716-722
• 12 Panse NS, Bhatt YC, Tandale MS. What is safe limit of the perforator flap in lower extremity reconstruction? Do we have answers yet?. Plast Surg Int 2011; 2011: 349357
• 13 Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992; 89 (06) 1115-1121
• 14 Akhtar S, Ahmad I, Khan AH, Khurram MF. Modalities of soft-tissue coverage in diabetic foot ulcers. Adv Skin Wound Care 2015; 28 (04) 157-162
• 15 Demiri E, Tsimponis A, Pavlidis L, Spyropoulou GA, Foroglou P, Dionyssiou D. Reverse neurocutaneous vs propeller perforator flaps in diabetic foot reconstruction. Injury 2020; 51 (Suppl. 04) S16-S21
• 16 Ibrahim A, Oneisi A. Lower Extremity Reconstruction. In: Abu-Sittah G, Hoballah J, Bakhach J. editors. Reconstructing the War Injured Patient. Cham, Switzerland: Springer Internacional Publishing; 2017: 79-88
• 17 Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg 1975; 56 (03) 243-253
• 18 Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region. A preliminary report. Scand J Plast Reconstr Surg 1983; 17 (03) 191-196
• 19 Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991; 44 (01) 53-54
• 20 Cho AB, Pohl PH, Ruggiero GM, Aita MA, Mattar TG, Fukushima WY. The proximally designed sural flap based on the accompanying artery of the lesser saphenous vein. J Reconstr Microsurg 2010; 26 (08) 501-508