Freestyle propeller flaps from the lower abdomen: A valuable reconstructive option for proximal thigh defects

Patel, Ketan M.; Sosin, Michael; Ramineni, Praful

doi:10.1002/micr.22205

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…The propeller flap, a pedicle based perforator flap, is well documented as an option for the majority of coverage in the lower limb, particularly below the knee, with the peroneal and posterior tibial artery perforators being commonly used [ 23 - 27 ].…”

Section: Reconstruction Options: the Reconstructionmentioning

confidence: 99%

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Jordan¹,

Malahias²,

Hindocha³

et al. 2014

TOORTHJ

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The lower extremities of the human body are more commonly known as the human legs, incorporating: the foot, the lower or anatomical leg, the thigh and the hip or gluteal region.The human lower limb plays a simpler role than that of the upper limb. Whereas the arm allows interaction of the surrounding environment, the legs’ primary goals are support and to allow upright ambulation. Essentially, this means that reconstruction of the leg is less complex than that required in restoring functionality of the upper limb. In terms of reconstruction, the primary goals are based on the preservation of life and limb, and the restoration of form and function. This paper aims to review current and past thoughts on reconstruction of the lower limb, discussing in particular the options in terms of soft tissue coverage.This paper does not aim to review the emergency management of open fractures, or the therapy alternatives to chronic wounds or malignancies of the lower limb, but purely assess the requirements that should be reviewed on reconstructing a defect of the lower limb.A summary of flap options are considered, with literature support, in regard to donor and recipient region, particularly as flap coverage is regarded as the cornerstone of soft tissue coverage of the lower limb.

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Section: Reconstruction Options: the Reconstructionmentioning

confidence: 99%

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Jordan¹,

Malahias²,

Hindocha³

et al. 2014

TOORTHJ

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“…28,35 Additionally, donor tissue tends to be uninvolved with infected and irradiated patients and no microsurgical technique is required in the reconstruction. 36 Although many strategies designed to address perineal defects including medial 37 and posterior thigh and gluteal flaps, [38][39][40][41][42] pudendal thigh flaps, 43 musculocutaneous gracilis flaps, 44,45 and abdominal-based flaps 46,47 exist, these alternatives either require position change, cannot provide necessary bulk, or further challenge otherwise compromised abdominal domain. Perhaps more importantly, we lack the vast collective experience that we have with ALT flap harvest to include these alternatives in an algorithm that has worked so well for us.…”

Section: Discussionmentioning

confidence: 99%

Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps

et al. 2014

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Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT-FC), myocutaneous (ALT-MC), or vastus lateralis myocutaneous (VL-MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity. Lower abdomen, groin, perineum, vulva, vagina, scrotum, and bladder wounds reconstructed in 22 patients using ALT flaps between 2000 and 2013 were retrospectively studied. Five ALT-FC, eight ALT-MC, and nine VL-MC flaps were performed. All flaps survived. Venous congestion occurred in three VL-MC flaps from mechanical cause. Wound infection occurred in six cases. Urinary leak occurred in three cases of bladder reconstruction. One patient died from congestive heart failure. The ALT flap is time tested and dependably addresses most LAPG defects; flap variations are suited for niche defects. We propose a novel algorithm to guide reconstructive decision-making.

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“…Although reconstruction is typically performed in pedicled fashion, the use of free flaps such as latissimus dorsi muscle, tensor fasciae lata, or ALT flaps is a reliable option, considered with increasing frequency a first choice by many experienced surgeons. Propeller design pedicled flap is another alternative, which has been used for coverage of soft tissue defects in abdominal region . However, the propeller flaps may not be suitable for large abdominal defects since they use the abdominal tissue itself for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Propeller design pedicled flap is another alternative, which has been used for coverage of soft tissue defects in abdominal region. 22,23 However, the propeller flaps may not be suitable for large abdominal defects since they use the abdominal tissue itself for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Coverage of supraumbilical abdominal wall defects: The tunnelled‐pedicled ALT technique

et al. 2015

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Abdominal wall defects are a challenge for reconstructive surgeons. Although the utility of anterolateral thigh perforator (ALT) flap has been well established for lower abdominal wall reconstruction, pedicled ALT flap is usually not considered for supraumbilical defects in the most recent algorithms. The purpose of this paper is to report the results of a tunneled pedicled ALT flap for reconstruction of supraumbilical defect from a series of patients. From July 2009 to September2014, six patients underwent delayed abdominal wall coverage using pedicled ALT flaps and reinforcement with polypropylene meshes. Defects occurred after surgical complications and abdominal trauma. Flaps were tunneled beneath the rectus femoris and sartorius muscles to increase the pedicle length. The size of the skin islands ranged from 22-29 × 10-14 cm. All flaps survived and the healing of the wounds was successful. Partial dehiscence of donor site occurred in one patient, and small wound dehiscence due to minimal distal necrosis was observed in another patient. No functional problems were reported in donor site, and no complications occurred in 6-68 months of follow-up. The tunneled pedicled ALT flap may provide a reliable alternative method for abdominal wall reconstruction, including supraumbilical defects. © 2015 Wiley Periodicals, Inc. Microsurgery 37:119-127, 2017.

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Freestyle propeller flaps from the lower abdomen: A valuable reconstructive option for proximal thigh defects

Cited by 6 publications

References 40 publications

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Flap Decisions and Options in Soft Tissue Coverage of the Lower Limb

Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps

Coverage of supraumbilical abdominal wall defects: The tunnelled‐pedicled ALT technique

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