A simple concept for covering pressure sores: wound edge‐based propeller perforator flap

Abstract

We present a new surgical modification to allow propeller perforator flaps to cover pressure sores at various locations. We used a propeller perforator flap concept based on the detection of newly formed perforator vessels located 1 cm from the wound margin and stimulated by the chronic inflammation process. Between January 2009 and January 2017, 33 wound edge-based propeller perforator flaps were used to cover pressure sores at various locations in 28 patients. In four cases more than one flap was used on the same patient. The patients comprised 18 males and 10 females with a mean age of 41·25 (range, 16-70) years. All patients underwent follow-up for 0-12 months. The mean follow-up duration was 5·03 months. Venous congestion was observed in three flaps that were rotated by 180° (9·1%). However, there was a significant difference between flaps rotated by 90° and 180° according to the complication rate (P = 0·034). Out of 33 flaps, 29 flaps healed uneventfully. Patients were able to sit and lie on their flaps three weeks after surgery. In our study, we were able to obtain satisfying final results using these novel flaps.

The Use of Magnetic Resonance Imaging in Planning a Pedicled Perforator Flap for Pressure Sores in the Gluteal Region

“…However, risk of venous congestion exists, especially when the flap is rotated by 180°. 17 It is also known that venous flow can be frequently compromised by twisting of the pedicle when the pedicle length is short, which is often encountered in the parasacral perforator flap. 18 Using perforator pedicles close to the zone of injury also increases the risk of vascular compromise, because inflammatory change and fibrosis around the perforator make the pedicle dissection difficult, and the fibrotic tissue can compress the pedicle when the flap is rotated.…”

Reconstructive Surgery of Pressure Injuries in Spinal Cord Injury/Disorder Patients: Retrospective Observational Study and Proposal of an Algorithm for the Flap Choice

“…In 2003, Pufe described how the blood supply around pressure sores is augmented due to the expression of angiogenic factors [ 25 ]. Based on this observation, in 2017, Kelahmetoglu described propeller perforator flaps based on enlarged perforators in the chronic PI margin [ 26 ]. Balakrishnan, in 2020, proposed the use of a single best perforator-based Pacman flap (SBPBPF) to cover pressure sores of any dimension, as it fortifies the advancement and transposition flap biogeometry principles with robust blood supply of perforator flaps [ 27 ].…”

Effective Salvage Surgery of a Severely Congested Propeller Perforator Flap Using a Postoperative Delay Technique and Negative-Pressure Wound Therapy

“…This flap often causes necrosis (incidence = 9.1% to 25.0%) due to overtension and twisting of perforators. [1][2][3][4][5] Flap necrosis is rarely found in cases of flap rotation of less than 110° but is often found (incidence = 21.4% to 33.0%) in cases of flap rotation of more than 110°. [1][2][3][4][5] The present flap, with a larger flap rotation of 150°, tended to cause poor circulation.…”