Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

Abstract

Background:The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent.Materials and Methods:We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series.Results:63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap.Conclusion:Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects.Level of Evidence:Therapeutic IV.

Recurrent branch of anterior interosseous artery perforator‐based propeller flap for distal forearm injuries: Report of 2 cases

“…Numerous similar perforator‐based flaps in the distal forearm have been well described in the published literature. The anterior interosseous artery perforator‐based flap is a well‐known flap for distal forearm reconstruction (Akin, ; Panse et al, ; Panse & Sahasrabudhe, ; Syed et al, ; Yii & Niranjan, ). However, to the best of our knowledge, there has been no report describing the recurrent branch of anterior interosseous artery perforator‐based propeller flap for distal forearm defects.…”

“…Perforator‐based propeller flaps can provide adequate soft tissue coverage for the distal forearm with antegrade venous drainage without sacrificing the major vessels (Hyakusoku, Yamamoto, & Fumiiri, ). Recently, there have been several reports focusing on the anterior interosseous artery perforator‐based flap; however, reports describing perforator‐based propeller flap in the distal forearm are rare (Akin, ; Panse et al, ; Panse & Sahasrabudhe, ; Syed et al, ; Yii & Niranjan, ). Here, we presented 2 cases of distal forearm defects following a farming machine injury and pyogenic extensor tenosynovitis that were repaired using the recurrent branch of anterior interosseous artery perforator‐based propeller flap.…”

Propeller Flap in Patient with Ewing’s Sarcoma in Lower Limb: A Case Report Study

“…It is effective, and its main complications include restricted arc of rotation or poor cosmetic result. A less common complication is reported in 4% of cases [3]. However, flap failure is associated with necrosis.…”

“…Propeller flap; Ewing's Sarcoma; Lower limb lower limb resulted in significant benefit [3]. Compared with skin connection of axial flap makes an awkward and unsightly twist at its base, which could risk kinking and stretching the pedicle and potentially cause the flap (dog ear) suffer.…”

“…Propeller flap is thought to cause congestion over the muscle, mainly due to compression. Arterial spasm concurrent with hematoma formation may also increase risk of bleeding [3,4]. Designing the flap continued until better closure of defect has been achieved.…”