抄録
A perforator-pedicled propeller (PPP) flap is often employed for reconstruction of the distal lower extremity. However, flap congestion that often causes flap necrosis occurs in the propeller flap. Although several procedures have been reported previously, a preferable method for preventing congestion and rescuing massive flap necrosis in PPP flap cases is undetermined.
A healthy 41-year-old man who sustained a pilon fracture in his right leg required soft tissue reconstruction because of strong edema that did resolve even after a staged protocol. A PPP flap pedicled with a perforator from the posterior tibial artery was harvested and rotated 180° to cover the defect. After reconstructive surgery, the flap developed severe congestion indicating the possibility of near-total flap loss. The flap was rescued by rotating it back to where its perfusion was stable. It was then rotated again in stages into the targeted position every 2 to 3 days over a period of 7 days. The flap was rescued and the wound was healed.
Delayed in-stage rotation of the flap was one of the options for salvaging a PPP flap from congestion especially in cases with severe soft tissue edema such as pilon fracture.
