Perforator Pedicled Propeller Flap: Innovative Solutions for Unstable Scar Reconstruction

This book chapter presents a case report and discussion on the use of the perforator pedicled propeller flap for the reconstruction of an unstable scar with central ulceration on the medial aspect of the right ankle. The chapter includes a detailed case presentation, operative procedure, and a comprehensive discussion of the surgical technique, advantages, and limitations associated with the propeller flap.

The case presentation describes a patient with a post-traumatic unstable scar on the medial aspect of the right ankle, resulting from a road traffic accident three years prior. Clinical examination revealed a benign nature of the ulcer and scar. The surgical intervention involved excision of the unstable scar and reconstruction using a reverse sural flap. The scar with ulceration and a 1 mm surrounding margin were excised, and the dimensions of the defect were measured. The reverse sural flap was raised, transposed to the defect, and the donor site was grafted with split-thickness skin grafts. The postoperative period was uneventful, and satisfactory results were observed during follow-up examinations.

The discussion section introduces the perforator pedicled propeller flap as a surgical technique used to cover soft tissue defects. The surgical technique, including patient evaluation and planning, flap design and marking, incision and flap elevation, and flap transposition and closure, is described in detail. The advantages of the propeller flap, such as preservation of major vessels, versatility, minimized donor site morbidity, and customization and precision, are discussed. The limitations, including vascular anatomy, flap reach and tension, and potential complications, are also addressed.

In conclusion, this book chapter provides valuable insights into the use of the perforator pedicled propeller flap for the reconstruction of unstable scars with central ulceration. Through a case report, operative details, and a comprehensive discussion, the chapter highlights the efficacy, considerations, and potential limitations associated with this surgical technique. This information can guide surgeons in making informed decisions and achieving successful outcomes in the reconstruction of soft tissue defects using the propeller flap.