Modified Anterior Tibial Artery Perforator-Pedicled Propeller Flap for Soft-Tissue Coverage of the Ankle and Heel

World J Surg. 2020 Jul;44(7):2237-2242. doi: 10.1007/s00268-020-05452-y.


Background: The ankle and heel are challenging regions to reconstruct functionally. Here, we explored the feasibility and clinical outcomes of a modified anterior tibial artery perforator-pedicled propeller flap for the repair of soft-tissue defects of the ankle and heel.

Patients and methods: Between January 2013 and December 2015, 12 patients with soft-tissue defects of the ankle and/or heel underwent reconstructive surgery that included our flap technique. The flaps measured 20 × 8 cm to 7 × 4 cm. A hand-held Doppler was used to identify a proper constant perforator in the distal ankle. In each case, the base of the flap was well preserved. The flap was transposed (180° rotation) to reach and cover the defect.

Results: The average follow-up time was 13 months (10-28 months). We observed good texture matches and contour in all of the flaps. All patients could walk and wear normal footwear. All but one flap survived completely without complications. Partial loss was observed in one patient, and the necrotic region was healed with secondary intention.

Conclusion: Our modified anterior tibial artery free-style perforator-pedicled propeller flap provides a novel option for functional ankle and heel reconstruction.

Level of evidence: Level IV.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Ankle / surgery*
  • Female
  • Heel / surgery*
  • Humans
  • Male
  • Middle Aged
  • Perforator Flap* / blood supply
  • Perforator Flap* / surgery
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Soft Tissue Injuries / surgery*
  • Tibial Arteries / surgery
  • Young Adult