Introduction. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. With the introduction of perforator flap, management of small- and medium-size defects of distal leg and ankle region is convenient, less time consuming, and with minimal donor site morbidity. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. Material and Methods. From June 2008 to May 2011, 20 patients were treated with perforator-based propeller flap for distal leg and ankle defects. Flap was based on single perforator of posterior tibial and peroneal artery rotated to 180 degrees. Defect size was from 4？cm × 3.5？cm to 7？cm × 5？cm. Results. One patient developed partial flap necrosis, which was managed with skin grafting. Two patients developed venous congestion, which subsided spontaneously without complications. Small wound dehiscence was present in one patient. Donor site was closed primarily in all patients. Rest of the flaps survived well with good aesthetic results. Conclusion. The perforator-based propeller flap for distal leg and ankle defects is a good option. This flap design is safe and reliable in achieving goals of reconstruction. The technique is convenient, less time consuming, and with minimal donor site morbidity. It provides aesthetically good result. 1. Introduction Soft tissue reconstruction of ankle region is difficult and challenging. Due to limited mobility and availability of overlying skin, even a small defect in the distal leg and ankle region may require a microsurgical reconstruction. Random pattern flap are limited in size and mobility [1]. Local fasciocutaneous flaps with limited availability in distal leg resulted in donor site that always require skin grafting. Free microvascular transfer leads to considerable donor site morbidity, is time consuming, and requires expensive microsurgical facility. The field of reconstructive surgery has taken a significant leap forward with the introduction of perforator flaps. This has been made possible with the development of knowledge in vascular anatomy and cutaneous circulation [2, 3]. According to the Gent consensus, perforator flaps are composed of skin and subcutaneous fat nourished by perforators rising from deep vascular systems, which reach the surface by passing mostly through muscle and intramuscular septa [4].
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