Comparison of free perforator flaps with local propeller perforator flaps for acute lower extremity reconstructions

Objectives: Adequate coverage of traumatic complex lower extremity wounds is often challenging for reconstructive surgeons. Local perforator flaps have gained wide acceptance as an alternative in soft tissue coverage of complex lower extremity defects over the last decade. Here, we report our experience with distal lower extremity reconstructions performed either with free or local perforator flaps. In the literature, no studies have been conducted that directly compare free flaps to propeller flaps; our aim here was to compare non-microvascular microsurgical flaps with free flaps for coverage of traumatic lower extremity wounds. Methods: 28 patients operated on for lower extremity defects and reconstructed either with free or local perforator flaps between February 2011 to June 2015 were included in the study. Age, gender, defect sizes, etiologies, and operation times were reviewed. Postoperative recipient and donor site complications, hospital stay, and additional surgical procedures were also analyzed. Results: There were 24 male and four female patients. Mean age was 43.11 years (range: 30 to 65 years) in the free perforator flap group and mean age was 44 years (range: 30 to 70 years) in the local perforator flap group. Hospital stay and overall operation time was significantly higher in the free flap group. There was no statistically significant difference in complication rates between either group. Conclusions: Concerning many advantages, like decreased operative time, avoiding micro anastomosis, and reconstruction with like tissues, we suggest that propeller perforator flaps can be the first-line reconstructive choice. These flaps can be used successfully by reconstructive surgeons in small clinics and they may prevent unnecessary tertiary medical center referrals as well as extended hospitalizations, long operation times, and increased costs.