Propeller Flaps

Abstract

A propeller flap is an islanded flap that reaches the recipient site through an axial rotation around its vascular axis. The degree of rotation varies from 90 degrees to 180 degrees. It is a highly reliable local reconstructive option. These flaps are simple, single-stage, easy to harvest, and not constrained by routine length-to-width ratios. Since their introduction, the technique has continued to evolve and more applications for the use of propeller flaps are being explored. In spite of their growing use in clinical practice in recent years, many reconstructive surgeons are unaware of their versatility, unsure of their safety, and apprehensive about using propeller flaps confidently. This article aims at understanding the nomenclature, key principles, biogeometry and planning, operative technical details, applications, and complications of propeller flaps.

Applications and Reliability of Dorsal Metacarpal Artery Perforator Flap

“…1,3,7 The flaps which are described based on the dorsal metacarpal artery system are DMAP flap, extended reverse dorsal metacarpal artery flap, and reverse dorsal metacarpal artery flap. [1][2][3][8][9][10][11][12] Flaps which can be based or elevated from the dorsum of the finger are extended reverse dorsal metacarpal artery flap, dorsal digital artery perforators flaps, kite flap, boomerang flap, intercommissural flaps, eponychial flap (which gives relative nail lengthening and better aesthetic appearance), and first dorsal metacarpal artery (mostly used for thumb defects). 9,[11][12][13][14][15][16][17][18][19] DMAP flap is based on the perforator which usually arises from the dorsal metacarpal artery at the level of the metacarpal neck distal to the juncture tendinae.…”

“…The flaps which are described based on the dorsal metacarpal artery system are DMAP flap, extended reverse dorsal metacarpal artery flap, and reverse dorsal metacarpal artery flap. 1 2 3 8 9 10 11 12 …”

“…Flaps which can be based or elevated from the dorsum of the finger are extended reverse dorsal metacarpal artery flap, dorsal digital artery perforators flaps, kite flap, boomerang flap, intercommissural flaps, eponychial flap (which gives relative nail lengthening and better aesthetic appearance), and first dorsal metacarpal artery (mostly used for thumb defects). 9 11 12 13 14 15 16 17 18 19 …”

“…The DMAP flap, like another propeller flap, has the disadvantage of having venous issues. 12 This can be overcome by keeping a fat cuff around the perforator and completely islanding the flap. We routinely elevate the operated hand for 2 days in intravenous stand to promote venous return.…”