Stepniewski Adam, Bingoel Alperen Sabri, Jäckle Katharina, Lehmann Wolfgang, Felmerer Gunther
Division of Plastic Surgery, Department for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany.
Department for Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany.
JPRAS Open. 2025 Mar 19;44:212-216. doi: 10.1016/j.jpra.2025.03.006. eCollection 2025 Jun.
Soft tissue defects in the lower leg often represent a therapeutic challenge. One of the treatment modalities is plastic reconstruction with a propeller flap. In our case report, we would like to present a case of a 75-year-old, multimorbid female patient who developed in the right distal lower leg, both medial and lateral, soft tissue defects after open reduction and internal fixation of a complex ankle fracture. She was treated by the single surgeon with two propeller flaps, one lateral and one medial, in the same operation. With this single-stage procedure, we achieved effective, long-term closure of the defect. It resulted in several advantages for the patient, including a shorter operation time compared to hypothetic two free flaps and no additional prolonged anesthesia. Also, defects were reconstructed according to the "like with like" principle, and less donor site morbidity compared to free muscle flaps. The disadvantage of the procedure was the need for split skin graft of the donor sites. Based on our experience, this method could be an option for carefully selected patients without high aesthetical demands who have undergone appropriate preoperative systemic and local optimization.
小腿软组织缺损常常是一项治疗挑战。治疗方式之一是采用推进皮瓣进行整形重建。在我们的病例报告中，我们想呈现一例75岁、患有多种疾病的女性患者，她在复杂踝关节骨折切开复位内固定术后，右小腿远端内外侧均出现了软组织缺损。同一位外科医生在同一台手术中用两个推进皮瓣对其进行了治疗，一个外侧皮瓣和一个内侧皮瓣。通过这一一期手术，我们实现了缺损的有效长期闭合。这给患者带来了几个优势，包括与假设的两个游离皮瓣相比手术时间更短，且无需额外延长麻醉时间。此外，缺损根据“同类修复同类”原则进行重建，与游离肌皮瓣相比供区并发症更少。该手术的缺点是供区需要进行断层皮片移植。基于我们的经验，对于经过适当术前全身和局部优化、审美要求不高且经过仔细挑选的患者，这种方法可能是一种选择。
