Risk Factor Analysis of Freestyle Propeller Flaps

Abstract

Freestyle propeller flaps have been widely used as a reconstructive option for both trunk and extremities. It offers the advantage of "like-with-like" reconstruction with an adjacent tissue with no dissection to the source vessels. However, there is the risk of vascular complications. In the present study, the authors investigated the incidence of vascular complications and their risk factors following freestyle propeller flap in the trunk and extremities. The authors conducted a retrospective review of 50 patients who underwent soft tissue reconstruction of the trunk and the extremities with 55 freestyle propeller flaps from 2004 to 2015. Data regarding patient demographics, surgical details, including the arc of rotation, and flap complications were collected from a prospectively maintained database and analyzed. There were 10 flap complications (18.2%), including 7 superficial partial necrosis, 2 full-thickness partial necrosis, and 1 total necrosis from the 55 freestyle propeller flaps harvested. Previous irradiation was a significant risk factor for flap complications and the propeller flap harvested from the extremities showed a significantly higher rate of complications compared with those harvested from the trunk. Complication rates were higher in flaps with the arc of rotation between 150 and 180 degrees with marginal significance compared with flaps with the arc of rotation less than 150 degrees. Freestyle propeller flaps proved to be a valid and reliable option for reconstruction of defects in the trunk, while complication rate was quite high in the extremities. A prudent preoperative evaluation and preparation may be necessary before performing this surgical technique in the extremities.

Retrospective Analysis in Lower Limb Reconstruction: Propeller Perforator Flaps versus Free Flaps

“…Though, it is still controversial whether preexisting patient comorbidities may influence the surgical outcome and represent real risk factors for complication, 12,19 as reported by Paik and Pyon. 20 Selection of the more adequate technique also depends on local factors, such as the possibility to achieve donor-site closure, presence of scars, perilesional tissue conditions, presence of edema, inflammation, thickness of subcutaneous tissue, and quality of recipients vessels and not least the surgical expertise.…”

“…Often though, when performing PPF, to avoid excessive tension, which compromises the local blood perfusion, STSGs are used to partially or sometimes wholly cover the donor site. 20 During the past years, we have become more aware of the potential and risks related to the use of PPFs and after an initial decrease of microsurgical procedures, we have switched back to a preferential use of FFs as first reconstructive option for coverage of defects of the lower limb.…”

Direction of Flap Rotation in Propeller Flaps: Does It Really Matter?

“…There is a consideration to be made as the retrospective group had more propeller flap reconstruction on the leg and this may play a role in increased complications as the perforators can be shorter. [28][29][30] In the prospective group with objective assessment of perforator flow, there were no flap losses (partial or total) and only two wound dehiscences. However, when statistically comparing the outcome between the two groups, there was no significance.…”

The Propeller Concept Applied to Free Flaps and the Proposal of a “Clock Flap” Nomenclature

“…We believe the application of the clock arms' parallelism to flap paddle components may be a synthetic and easily understandable way to define the operative technique which may be useful to colleagues having to cope with early microvascular complications in such complex procedures, as well as to surgeons trying to classify their flaps for statistical analysis, as many authors are already doing with pedicled propeller flap case series, trying to formulate standard rules to minimize vascular complications. 7,[12][13][14][15][16]…”