Rescue for Partially Necrotic Peroneal Propeller Flap Using Free Perforator Flap From Same Flap

Summary: Distal partial necrosis is a frequent complication of propeller flaps and similar pedicled flaps, with reported incidences up to 21%. This report describes the case of a 2-year-old patient who underwent reconstruction of a posterior ankle soft-tissue defect using a peroneal artery–based propeller flap. The procedure was complicated by postoperative partial flap necrosis. On postoperative day 2, a free peroneal perforator flap was harvested from the viable proximal segment of the original flap to provide secondary wound coverage. The transferred flap survived completely, resulting in excellent soft-tissue coverage and functional outcomes, despite moderate hypertrophic scarring. Although based on a single case with a suboptimal vascular anastomosis, this approach represents a useful salvage strategy option for partial necrosis of propeller flaps and similar reconstructions.