Propeller posterior tibial artery perforator flap for reconstruction of the medial malleolar defect: A case report

Traumatic injury to the distal third of the lower leg remains challenging and often requires free tissue transfer. Reconstructive options for lower leg soft-tissue defects require comprehensive evaluation. A 20-year-old man presented with a medial malleolar soft-tissue defect with exposure of the great saphenous vein, distal tibia, and ankle joint after a traffic accident. Negative pressure wound therapy provided only partial coverage of the exposed tissue. The defect was reconstructed using a local fasciocutaneous propeller flap based on a septocutaneous perforator from the posterior tibial artery. At 1-year follow-up, the patient resumed normal daily activities without functional deficits. We review the options of reconstructing the distal third of the lower leg and surgical pearls of propeller flaps. Propeller flaps provide adequate tissue-like and pliable soft tissue coverage with a short operation time. It can be a useful technique for the reconstruction of distal third lower-leg defects.