Double-pedicle propeller flap for reconstruction of the foot and ankle: anatomical study and clinical applications.

Objective Reconstruction of soft tissue defects in the foot and ankle remains challenging. This study was performed to investigate the technical points and clinical effects of a double-pedicle propeller flap for repair of foot and ankle soft tissue defects. Methods We used five fresh calf specimens to investigate the anatomical and operative aspects of a double-pedicle propeller flap. Eighteen patients with soft tissue defects in the foot and ankle subsequently underwent defect repair with double-pedicle propeller flaps. Results The anatomical study showed that the peroneal artery perforators and the sural nerve bundle (two blood supply systems) provided the theoretical anatomical basis for the double-pedicle propeller flap. The relative positions of the peroneal artery perforators and the sural nerve bundle differ according to the peroneal artery perforating level. Flap rotation in different directions can reduce or prevent the pedicles from compressing each other. All flaps survived, and three flaps developed local epidermal necrosis at the proximal end; these flaps healed after 1 to 2 weeks of dressing changes. The other 15 patients healed well. Conclusions The double-pedicle propeller flap can enhance the blood supply and venous return in the "big paddle" region of the flap, reducing the distal necrosis rate.