Perforator-based propeller flap with venous axial supercharging for reconstruction of a leg defect

Horta, Ricardo; Valença‐Filipe, Rita; Nascimento, Ricardo; Monteiro, Diana; Silva, Álvaro; Amarante, José

doi:10.1016/j.injury.2014.09.013

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…In the scenario of flap congestion, one may also consider the option of supercharging the flap. Both Ono et al 35 and Horta et al 36 have described supercharging perforator flaps to increase flap viability, particularly for larger flaps harvested beyond the designated perforasome. Venous congestion is the most common postoperative complication and supercharging is a practical strategy to prevent this.…”

Section: Approach To a Defectmentioning

confidence: 99%

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

Low

Sebastin

Cheah

2019

Indian J Plast Surg

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Lower extremity soft tissue defects frequently result from high-energy trauma or oncological resection. The lack of suitable muscle flap options for the distal leg and foot makes defects in these locations especially challenging to reconstruct and free tissue transfer is commonly used. Another option that has become more popular in the past two decades are pedicled perforator flaps. Based on a thorough literature review and the authors’ experience on leg perforator flaps for over a decade, this article presents a historical review, the anatomical basis of common perforator flaps of the leg and foot, patient selection, wound selection, perforator selection, flap design, surgical techniques, refinements, and postoperative care. A review of the clinical outcomes and complications of these flaps was also performed and was noted to be comparable to the outcomes of free tissue transfer with significantly lower total flap failure rate. It is hoped that this review will assist surgeons in the formulation of a comprehensive step-by-step guide in performing pedicled perforator flap reconstruction of the lower extremity.

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Section: Approach To a Defectmentioning

confidence: 99%

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

Low

Sebastin

Cheah

2019

Indian J Plast Surg

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“…Horta et al (2014) published a case report about lower limb reconstruction in which a venous branch of the great saphenous vein was found at the same rotational plane of the posterior tibial artery perforator propeller flap and included in it to augment venous drainage and the flap survival.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, the flap could be derotated to its original position delaying wound closure. Postoperatively, venous congestion can be approached with local heparinization, small punctures or leeches application (Horta et al, 2014). Venous supercharging is technically more complex to perform and adds a microsurgical procedure with increased operative time, but it represents an effective approach to enhance flap survival and substantially limit complication rate (Zheng et al, 2016), as shown by increased blood perfusion and transcutaneous oxygen pressure.…”

Section: Introductionmentioning

confidence: 99%

Conjoined thoracodorsal perforator‐supercharged dorsal intercostal artery perforator propeller flap for reconstruction of a complex upper back defect: Case report and review of the literature on supercharged pedicled perforator flaps

Brunetti,

Salzillo,

De Bernardis

et al. 2023

Microsurgery

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The reported complications' rate of perforator propeller flaps is variably high, but the etiology of distal flap necrosis, potentially linked to vascular insufficiency, is yet to be clarified. Vascular augmentation procedures have been previously described involving an extra anastomosis of a superficial vein, while a perforator‐to‐perforator supercharging approach has been only sporadically documented in literature. We present a case of perforator‐to‐perforator vascular supercharging of an extended dorsal intercostal artery perforator (DICAP) propeller flap to provide a salvage option for pedicled flap complicated by venous congestion. A 71‐year‐old male patient underwent Dermatofibrosarcoma Protuberans resection in the upper back, leading to a 17 × 17 cm defect with bone exposure. A 30 × 9 cm DICAP propeller flap was planned, with the distal third of the flap designed over the adjacent Thoracodorsal artery perforasome, in a conjoined fashion. Considering the small DICAP pedicle caliber and the flap lateral extension, a thoracodorsal artery perforator vein was dissected and included in the distal flap. Once the flap was raised on its main pedicle, the skin paddle turned blue, showing signs of venous insufficiency. Indocyanine green angiography (ICG) showed a viable proximal half of the flap. Hence, after rotating the skin paddle to reach the upper margin of the defect, an additional anastomosis between the perforating thoracodorsal vein and the perforating vein of the dorsal scapular pedicle was performed according to the perforator‐to‐perforator approach. Doing so, both clinical and ICG examinations showed a well perfused flap, with normal capillary refill. The postoperative course was uneventful, and the patient obtained a good oncological and reconstructive result 4 months postoperatively. The second Vasconez law (“all of the flap will survive except the part that you need”) is often encountered in propeller flaps surgery. Our case shows that it is possible to prevent or overcome this problem by planning appropriate vascular augmentation procedures according to the perforator‐to‐perforator approach, being guided by advanced vascular imaging tools like ICG.

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“…We also found reports on venous supercharging procedure for the free flaps, such as the DIEP flap, allowing a decrease of complications and failure (Boutros, ; Riot et al, ). Nonetheless, PPF of the lower limb has been less studied, with only one case reported by Horta et al on an open tibia fracture (Horta et al, ). Described by Hyakusoku et al in 1991, the use of perforator flap propellers lead to a twist of the pedicle and thus frequently limit venous return (Hyakusoku et al, ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: A prospective study

et al. 2017

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Perforator-based propeller flap with venous axial supercharging for reconstruction of a leg defect

Cited by 4 publications

References 5 publications

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

A Review of Pedicled Perforator Flaps for Reconstruction of the Soft Tissue Defects of the Leg and Foot

Conjoined thoracodorsal perforator‐supercharged dorsal intercostal artery perforator propeller flap for reconstruction of a complex upper back defect: Case report and review of the literature on supercharged pedicled perforator flaps

Comparison of propeller perforator flap and venous supercharged propeller perforator flap in reconstruction of lower limb soft tissue defect: A prospective study

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