D108. Propeller Flap Closure Is Superior to Skin Grafts for Reconstruction of the Osteocutaneous Fibula Flap Donor Site: Anatomical Considerations and Outcomes

PURPOSE: This retrospective study details the surgical anatomy of harvesting a local fasciocutaneous propeller flap for osteocutaneous fibula flap donor site closure and compares outcomes to patients who underwent skin graft closure. METHODS: The study compared 21 patients who underwent local flap reconstruction compared to 195 patients who underwent skin graft for fibula flap donor site reconstruction. RESULTS: There were no significant differences between the two groups based on age, BMI, presence of peripheral vascular disease, obesity, or type 2 DM. All propeller flap closures were eccentrically designed on a proximal lower leg perforator. The average distance of this perforator from the fibular head was 13.4±2.0 cm. Most of these perforators were musculocutaneous through the soleus muscle (n=19, 90.5%) and the rest were septocutaneous (n=2, 9.5%) originating directly from the peroneal artery. The average defect size was 69.9±28.3 cm2 and the average propeller flap size was 80.3±26.2cm2. Three patients experienced distal partial flap loss and one patient required additional full-thickness skin graft. All other patients achieved complete healing. In comparison, the average skin graft size was 65.3±31.9cm2. Half of patients (n=96, 49.2%) patients had incomplete skin graft take. The average skin graft loss was 34.3% and the average length of dressing changes required was 51.6±52.8 days. CONCLUSION: The study findings demonstrate that local propeller flaps can be utilized with reasonable success to close fibula flap donor sites and are preferred to skin graft closure when anatomically feasible.