30 巻 (2017) 1 号 p. 20-26
Although perforator based-propeller flaps have become recently popular in the reconstruction for several soft tissue defects, the usefulness in traumatic tissue problems has not been clarified. We investigated 8 cases with traumatic soft tissue defects in the lower leg treated using posterior tibial artery perforator-based propeller flap ( PTPF ) in our hospital. The average patient age was 58 years old. Most of the original diagnoses were distal tibial fractures ( including 2 open fractures ). The average duration from soft tissue damage to flap operation was 44 days. We could not use the perforators identified by preoperative ultrasound examination in three cases because of scar formation and diffuse edema. The flap survived in 6 cases. One flap exhibited partial necrosis and 1 flap was completely necrotic, and those 2 cases needed additional free flap operations for soft tissue coverage. In addition, there was soft tissue necrosis around the transferred flaps in 2 cases, infection in 2 cases, and delayed bone union in 3 cases. Although PTPF is thought to be useful in traumatic cases, we should pay more attention to the zone of injury surrounding the defects, as well as make a detailed plan for selection of proper perforator, flap design, and fracture management.