Propeller Flaps for Reconstruction of Defect over Leg and Foot: Clinical Application and Management of Complications

Propeller flaps have emerged as a reliable reconstructive option for managing leg and foot defects, offering advantages such as minimal donor-site morbidity and versatility in defect coverage. However, complications such as vascular compromise, flap necrosis, and donor site challenges remain concerns that necessitate meticulous surgical planning and management. This study investigates the clinical applications of propeller flaps, emphasizing their outcomes, complications, and strategies to optimize success rates.

A total of 31 patients (mean age: 39.74 ± 8.97 years) with leg and foot defects of varied etiology requiring flap coverage were included. Flap dimensions ranged from 15 cm² to 200 cm², with rotation angles between 90° and 180° (mean: 145.00 ± 33.44°). Flaps were based on posterior tibial (n=15), peroneal (n=11), and anterior tibial perforators (n=5).

Overall, the survival rate of propeller flaps in this study was 74.2%, with complete flap loss in four cases (12.9%) and partial flap loss in four cases (12.9%). Venous congestion was observed in six cases (19.4%), two of which required venous supercharging within 48 hours postoperatively. Donor sites were successfully covered using split-thickness skin grafts in all cases.

Compared to traditional local or free flap techniques, propeller flaps demonstrated comparable efficacy but with potentially reduced operative complexity and donor-site morbidity. By elucidating key surgical principles—such as meticulous dissection, optimized flap design, and strategic rotation to preserve vascularity—this study provides actionable insights for improving outcomes. Furthermore, it underscores the importance of early recognition and intervention in managing complications, thereby enhancing patient care in reconstructive surgery.

This comprehensive evaluation of propeller flap techniques contributes to advancing the field of leg and foot reconstruction, reinforcing their value as a versatile and effective solution in the reconstructive surgeon's repertoire.