title: Reconstruction of soft tissue defects of the Achilles tendon with rotation flaps, pedicled propeller flaps and free perforator flaps.
abstract: BACKGROUND
  Soft tissue defects exposing the Achilles tendon are challenging. Local perforator flaps represent a valuable option gaining increasing popularity. Despite preoperative planning an adequate perforator cannot always be found intraoperatively. The free peroneal artery perforator flap can serve as a back-up option limiting the donor site morbidity to the same extremity without sacrificing major vessels or nerves.
  
  
  METHODS
  Nine patients with soft tissue defects exposing the Achilles tendon were treated with local perforator flaps, seven were scheduled for 180° propeller flap coverage after Doppler-ultrasound examination. However, in two patients (22%) no adequate perforators were found intraoperatively. As the perforators for the free peroneal artery perforator flap were routinely mapped out, this flap was harvested for microsurgical reconstruction.
  
  
  RESULTS
  One patient with a 180° propeller flap developed a partial flap necrosis, another patient developed superficial epidermolysis, both requiring skingrafting. no complications were seen with free tissue transfer.
  
  
  CONCLUSIONS
  Pedicled perforator flaps as propeller flaps add options to the armamentarium of microsurgeons. Despite thorough preoperative planning the surgeons must be prepared to perform a different method of reconstruction if inadequate vessels are encountered. To limit additional donor site morbidity, local options are preferred. The free peroneal artery perforator flap represents a good option as it matches the original tissue properties closely. The complication rate of propeller flaps in this series is tolerable. Propeller flaps should therefore be considered an alternative but not as a replacement of local fasciocutaneous flaps.
authors.affiliation: Department of Trauma, Plastic and Hand Surgery, Julius-Maximilian-University of Wuerzburg, Germany. Jakubietz_R@klinik.uni-wuerzburg.de
authors.forename: Rafael G
authors.initials: RG
authors.lastname: Jakubietz
authors.forename: Danni F
authors.initials: DF
authors.lastname: Jakubietz
authors.forename: Joerg G
authors.initials: JG
authors.lastname: Gruenert
authors.forename: Karsten
authors.initials: K
authors.lastname: Schmidt
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Meffert
authors.forename: Michael G
authors.initials: MG
authors.lastname: Jakubietz
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000293:Adolescent; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D018608:Ultrasonography, Doppler