Background: Compound fractures of the leg require reconstruction with flaps to ensure faster recovery and prompt return to functionality. Compared to the other flaps, propeller perforator flaps are the most recent discovery. They have been used to cover defects of the distal leg with few cases reported for the proximal third of the leg probably due to the fact that many options are already available. We present our experience with the use of these flaps for defects of the upper third leg.
Objective: To prospectively audit patients with defects of the proximal leg operated on with propeller flaps Study Design: This was a prospective review of patients operated on with propeller perforator flaps to cover defects of the proximal third of the leg between January 2014 and December 2024. An appropriate perforator was identified with the use of hand held Doppler in the proximity of the wound after which a propeller flap was raised and rotated into the defect. The donor site was then either closed primarily or with a skin graft. Post operatively patients were reviewed at a regular interval for at least one year to determine on the outcomes.
Study Setting: The study was carried out at various facilities in Nairobi including Kenyatta National Hospital, Coptic Mission Hospital and the Nairobi Hospital Study Subjects/Participants: Thirty five (35) patient with defects involving the proximal third of the leg covered with propeller flaps.
Results: A total of 35 patients were operated on with perforator flaps in the said study duration. 31 patients had wounds with exposed bone with 4 patients below knee amputation stumps. The mean age for the patients was 46.7 years with a range of 18 to 67 years. Forty seven (47) percent of the flaps were based on the posterior tibial vessels with the rest on the peroneal and anterior tibial vessels. Flap success rate was more than 91 percent with only three flaps having partial necrosis. There was no case
of complete flap failure.
Conclusion: Perforator flaps are reliable flaps for reconstruction of defects in the proximal leg. They have less donor and recipient site morbidity. They should thus be considered in armamentarium of reconstruction options.