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Original Article • Rev. bras. ortop. 57 (05) • Sep-Oct 2022 • https://doi.org/10.1055/s-0041-1740199 copy

Comparative Analysis of the Treatment of Skin Lesions of the Lower Limbs with Sural Flap versus Propeller Flap^* Study developed at the Hand and Microsurgery Group of the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The objective of the present study was to prospectively compare the sural and propeller flaps for soft-tissues coverage of the lower extremity. The following variables were evaluated: incidence of complete or partial flap loss and donor area morbidity (primary closure versus skin graft).

Methods

Prospective and randomized analysis of data collected from all patients presenting with soft tissue defects of the lower third of the leg and heel treated with reverse sural or propeller flaps.

Results

Twenty-four patients aged between 4 and 60 years old were evaluated between 2011 and 2017. Complete coverage was obtained in 22 of the 24 patients (91.6%). Two flaps failed (8.4%). The sural flap, being the most popular option, continues to represent a safe and versatile alternative for skin defects of the lower third of the leg and heel region. Likewise, the propeller flap was a comparable option to treat these challenging defects.

Conclusion

Sural and propeller flaps are good options for soft tissues coverage of the lower extremity, with low complication rates (partial or total flap loss).

Keywords
perforator flap; surgical flaps; transplant donor site

No.	Age	Gender	Location	Comorbidities	Etiology	Flap	Artery of origin	Dimensions
1	28	M	Lateral malleolus	Denies	Open fracture	Propeller	FA	13 × 6 cm
2	42	M	Medial malleolus	Denies	Trauma	Sural	mSA	11 × 4 cm
3	31	M	AP Ankle Region	Denies	Accident with chainsaw	Propeller	PTA	22 × 7 cm
4	58	F	Heel and back region of the foot	RA	Open fracture	Sural	mSA	10 × 5 cm
5	57	M	AP Ankle Region	Denies	Postoperative dehiscence	Propeller	FA	12 × 6 cm
6	4	M	Medial malleolus	Denies	Run over	Propeller	PTA	18 × 7 cm
7	26	M	AP Ankle Region	Denies	Open fracture	Sural	mSA	19 × 6 cm
8	25	M	Medial malleolus	Denies	Motorcycle accident	Sural	mSA	14 × 8 cm
9	49	M	Lateral malleolus	Abdominal Ao aneurysm	Ankle fracture-dislocation	Sural	mSA	10 × 6 cm
10	23	M	Lateral malleolus	Denies	Open fracture	Sural	mSA	10 × 8 cm
11	36	F	Lateral malleolus	Sickle-cell anemia	Bimalleolar open fracture	Propeller	FA	15 × 5 cm
12	43	M	AP Ankle Region	Denies	Sequelae of exposed fracture	Propeller	PTA	15 × 8 cm
13	59	M	Lateral malleolus	Denies	Trauma	Sural	mSA	15 × 8 cm
14	42	M	Medial malleolus	Smoker	Run over	Propeller	PTA	19 × 6 cm
15	47	M	Heel and back region of the foot	Lymphoma in Hodking	Open calcaneus fracture	Sural	mSA	9 × 6 cm
16	18	M	Lateral malleolus	Denies	Postoperative dehiscence	Sural	mSA	10 × 7 cm
17	17	M	Lateral malleolus	Denies	Trauma	Sural	mSA	10 × 6 cm
18	59	M	Medial malleolus	Denies	Tibial pylon fracture	Propeller	PTA	20 × 6 cm
19	28	M	Medial malleolus	Denies	Open fracture	Propeller	PTA	18 × 5 cm
20	36	M	Heel and back region of the foot	Denies	Trauma	Propeller	PTA	20 × 4 cm
21	60	M	AP Ankle Region	Denies	Gunshot wound	Propeller	PTA	14 × 4 cm
22	33	M	Lateral malleolus	Denies	Sequela of tibial pylon fracture	Sural	mSA	10 × 6 cm
23	43	M	Heel and back region of the foot	Denies	Calcaneus fracture	Sural	mSA	10 × 5 cm
24	41	M	AP Ankle Region	Smoker	COM	Sural	mSA	9.5 × 6.5 cm

	Sural Group	Propeller Group
Patients (n. of cases)
Men	12	10
Women	1	1
Age (years)
Statistical average ± SD	38.30 ± 5.63	35.25 ± 3.89
Maximum	60	59
Minimum	04	17
Primary disease (n. of cases)
Post-traumatic injury	11	9
Surgical complication: dehiscence	0	1
Chronic ulcer	1	1
Chronic infection	1	0
Location for reconstruction (n. of cases)
Malleolar	8	7
Ankle	2	4
Heel and back of foot	3	1

	Sural Group	Propeller Group
Flap Dimensions (Mean ± SD; range)			t-test
Compliance (cm)	11.35 ± 2.8; 19.0–9.0	16.91 ± 3.2;20.0 - 12.0	p= 0.0002
Width (cm)	6.2 ± 1.2; 8.0–4.0	5.8 ± 1.2;8.0 - 4.0	p= 0.38
Area (cm²)	71.98 ± 26.3; 120–44	98.64 ± 29.8; 154 - 56	p= 0.02
Closure of the donor area (n. of cases [%])			Chi-squared test
Primary	10 (41.67%)	6 (25.0%)	p= 0.17
Graft	3 (12.50%)	5 (20.8%)	p= 0.34
Postsurgical complications (n. of cases [%])
Infection	1 (4.10%)	2 (8.30%)	p= 0.57
Partial necrosis	2 (8.30%)	3 (12.50%)	p= 0.62
Total necrosis	2 (8.30%)	0 (0%)	p= 0.24
Additional surgery (n. of cases)
Graft	1	2
New flap	3	1
Repositioning	0	1

		Complications					Total
		No.	Infection	Partial loss	Repositioning	Total loss	Total
Flap	Sural	9	1	1	0	2	13
Flap	Propeller	7	2	1	1	0	11
Total		16	3	2	1	2	24

		Closing of the donor area		Total
		Primary	Graft	Total
Flap	Sural	10	3	13
Flap	Propeller	6	5	11
Total		16	8	24

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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