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Background: Reconstruction of soft tissue defects in theleg and the foot remains challenging. Anatomical constraintslimit the options available for reconstructing complex defectsespecially lower third of leg. Perforator propeller flaps areraising interest in reconstructive surgery of the limbs. Wepresent our experience with perforator propeller flaps forreconstruction of soft tissue defects in leg and foot with anemphasis on the safe limit of a perforator flap in the lowerlimb.Methods: The study was carried prospectively and 32patients with leg or foot defects treated with various perforatorpropeller flaps (both elective as well as emergency) wereincluded in the study. A hand-held ultrasound Doppler wasused pre-operatively and intraoperatively to detect the perforatorvessels.Results: Out of the 32 cases, we witnessed total flap lossin one and distal necrosis in 6 cases. In 4 of them the flapslengths were more than one third of the limb length. 8 patientshad minor complications which included congestion, infectionor graft loss.Conclusion: Perforator flaps may represent a good alternativeto the free flaps in the areas were other local reconstructiveprocedures are not possible. This is a versatiletechnique and with decreased donor site morbidity limited toa single body area. There is a specific like to like soft tissuereplacement leading to a better cosmetic and reconstructiveoutcome. The main drawback of the perforator flaps howeveris the higher risk of venous congestion. The incidence of distalnecrosis increases with flap length more than one third of thelimb provided other factors affecting flap vitality are constant.

Propeller Flaps for Reconstructing Leg and Foot Defects: The Relation between Flap Length and the Incidence of Ischemia