OBJECTIVE

To explore the feasibility and technical essentials of soft tissue defect reconstruction following malignant tumor removal of limbs using perforator propeller flaps.

METHODS

Between July 2008 and July 2015, 19 patients with malignant limb tumor underwent defect reconstruction following tumor removal using the perforator propeller flaps. There were 13 males and 6 females with an average age of 53.4 years (range, 20-82 years). The disease duration ranged from 1 to 420 months (mean, 82 months). The tumors located at the thigh in 10 cases, at the leg in 2 cases, at the arm in 1 case, at the forearm in 1 case, around the knee in 2 cases, and around the elbow joint in 3 cases. Totally 23 flaps (from 8 cm x 3 cm to 30 cm x 13 cm in size) were used to reconstruct defects (from 4 cm x 4 cm to 24 cm x 16 cm in size). The potential source arteries included the femoral artery (n = 2), profunda femoral artery (n = 3), superficial circumflex iliac artery (n = 1), lateral circumflex femoral artery (n = 6), superior lateral genicular artery (n = 2), peroneal artery (n = 2), anterior tibial artery (n = 1), brachial artery (n = 4), and radial artery (n = 1). The remaining one was a free style perforator flap.

RESULTS

Partial distal flap necrosis occurred in 3 cases after surgery with rotation angles of 180, 150, and 100 degrees respectively, which were reconstructed after debridement using a free-style perforator flap in 1 case and using free skin grafting in the other 2 cases. The other 20 flaps survived completely after surgery. Primary healing of incisions was obtained at the donor and recipient sites. There was no severe complication such as infection, hematoma, and total flap failure. All patients were followed up 3 months to 5 years (mean, 19 months). One patient with malignant melanoma around the elbow joint had tumor recurrence, and underwent secondary tumor resection. The appearance, texture, and color of the flaps were similar to those at the recipient site.

CONCLUSION

For patients with malignant tumor of the limb, the perforator propeller flap can be an alternative option for soft tissue defect reconstruction after tumor resection, with the advantages of relatively simple operation and remaining the main vessels.