How to Design and Harvest a Propeller Flap

Abstract

Propeller flaps are local flaps based either on a subcutaneous pedicle, a single perforator, or vessels entering the flap in such a way so as to allow the flap to rotate on their axis. Depending on the kind of pedicle and the anatomical area, the preoperative investigation and the harvesting techniques may vary.An adequate knowledge of skin and subcutaneous tissue perfusion in the different areas of the body is very important to plan a propeller flap to be successful.The surgeon should begin by finding the most suitable perforators in the area surrounding the defect using available technology. The position, size, and shape of the flap are planned about this point.For perforator-pedicled propeller flaps, the procedure starts with an exploration from the margins of the defect or through a dedicated incision to visualize any perforators in the surroundings. The most suitable perforator is selected and isolated, the skin island is replanned, and the flap is harvested and rotated into the defect. The variations in surgical technique for other types of propellers and in specific anatomical areas are also described.Compared with free flaps, propeller flaps have the advantage of a simpler, shorter operation, without the need for a recipient vessel for microanastomosis.Yet, from a technical point of view, an adequate experience in dissecting perforators and the use of magnifying glasses are almost always required.

Immediate Soft Tissue Reconstruction in Lower Limb Traumas Using Propeller Perforator Flaps

“…28 On the other hand, these flaps require delicate dissection and careful isolation of the pedicle, and their vascular anatomy is rarely constant. Complications' rate ranges from 8.3% to 42%, [25][26][27][28][29][30][31] reporting most frequently venous congestion (up to 17%), which usually resolves spontaneously. Superficial necrosis can occur in about 11% of patients and usually requires additional surgery for debridement and skin grafting, whereas full-thickness and total flap loss are uncommon.…”

Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery

“…Avoiding twisting of the vascular pedicle is essential for the viability of a propeller flap 18 . Wong et al 21 used a finite element procedure to analyze the factors that influence vascular patency.…”

“…Accurate localization and identification of the pedicle vessels is crucial when performing propeller flap surgery. 18 According to the classification system by Mathes and Nahai, 19 the lower trapezius muscle can be classified as a type V muscle with the DSA as the dominant pedicle. 10 Anatomic findings confirmed that there was a constant blood supply to the lower trapezius muscle via the DSA.…”

“…Avoiding twisting of the vascular pedicle is essential for the viability of a propeller flap. 18 Wong et al 21 used a finite element procedure to analyze the factors that influence vascular patency. They concluded that vascular patency is best maintained by selecting a vessel that is approximately 1 mm in diameter and at least 30 mm in length.…”

A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report

“…However, vascular anomalies of the supraclavicular artery exist [8]. Some anatomical studies on how to improve the reliability of supraclavicular flaps have argued that anatomical knowledge of local perforasomes and vascular systems is very important because the supraclavicular flap is mostly based on relatively small and superficial perforators [9][10][11].…”