Current applications of propeller flaps in reconstruction of trunk wounds

Abstract

Aim:Propeller flaps provide excellent reconstructive options for defects of many etiologies. Trunk wounds are a commonly encountered issue for the plastic surgeon and multiple techniques to address them should be prepared for implementation. Propeller flaps are a subject rarely brought up as an option to address these wounds. The authors sought to elucidate this topic in the current plastic surgery literature available. Methods: A PubMed search was conducted based upon the defined inclusion and exclusion criteria and publications reviewed in detail. Search terms included "trunk wound propeller flap", "trunk propeller flap", and "freestyle trunk wound flap". Duplicate studies were excluded. Data was extracted from each study pertaining to trunk wounds and reconstructions with propeller flaps. Results: The electronic search yielded 49 results with 21 studies ultimately meeting inclusion criteria. A total of 365 flaps were described collectively amongst the included studies. Among them, 190 propeller flaps addressing trunk defects were performed across all studies reviewed to address a total of 165 defects of the trunk: 14 abdomen, 101 back, 50 chest defects and adjacent respective flaps were utilized for surgical reconstruction. Overall, cancer excision wounds were by far the most prevalent with 105 cases (59.0%). Defect sizes of those specified in the articles ranged from 2 cm × 5 cm to 30 cm × 24 cm. Of the 190 propeller flaps identified, 63 total complications were identified. The most common complication was 48 total cases of transient venous congestion (25.3%). The second most common complication was partial flap necrosis (6.3%). No total flap loss was noted. There were 2 cases of seroma (1.1%) and 1 case of wound breakdown (0.5%). Conclusion: Propeller flaps are a viable reconstructive option for trunk wounds and should be in the armamentarium of plastic and reconstructive surgeons. Few studies are available in the literature regarding propeller flap reconstruction in trunk wounds. More aggregate data is needed in order to further review, evaluate, and refine propeller flap techniques and results. ABSTRACT

Propeller Flaps

“…They noted no incidence of total flap necrosis. 52 D' Arpa et al noted that the longer length of perforators over the trunk permits a greater range of movement, allowing an extensive arc of rotation with little concern about the torsion of the perforator and the blood supply. Studies have demonstrated that large flaps with an orientation perpendicular to the longitudinal axis of the cutaneous dermatomes can be successfully transferred to the trunk 53 ( Fig.…”

Our Definition of Propeller Flaps and Their Classification

“…Concurrently, a few scattered publications started to appear in the English literature describing the propeller flap experiences of different groups, in the lower limb, [10][11][12][13] and in other parts of the body, 14,15 from the upper limb 16,17 to the face [18][19][20][21][22] and to the trunk. 23,24 At the First Tokyo Meeting on Perforator and Propeller Flaps, in 2009, faculty and colleagues gathered from all around the world to present their experiences. On that occasion, they proposed both a definition and a classification schema for propeller flaps, as this was absent until then.…”