The Utility and Versatility of Perforator-Based Propeller Flaps in Burn Care

Abstract

The majority of surgical burn care involves the use of skin grafts. However, there are cases when flaps are required or provide superior outcomes both in the acute setting and for postburn reconstruction. Rarely discussed in the context of burn care, the perforator-based propeller flap is an important option to consider. We describe our experience with perforator-based propeller flaps in the acute and reconstructive phases of burn care. We reviewed demographics, indications, operative details, and outcomes for patients whose burn care included the use of a perforator-based propeller flap at our institution from May 2007 to April 2015. Details of the surgical technique and individual cases are also discussed. Twenty-one perforator-based propeller flaps were used in the care of 17 burn patients. Six flaps (29%) were used in the acute phase for coverage of exposed joints, tendons, cartilage, and bone; coverage of open wounds; and preservation of range of motion (ROM) by minimizing scar contracture. Fifteen flaps (71%) were used for reconstruction of postburn deformities including coverage of chronic wounds, for coverage after scar contracture release, and to improve ROM. The majority of flaps (94% at follow-up) exhibited stable soft tissue coverage and good or improved ROM of adjacent joints. Three cases of partial flap loss and one case of total flap loss occurred. Perforator-based propeller flaps provide reliable vascularized soft tissue for coverage of vital structures and wounds, contracture release, and preservation of ROM across joints. Despite a relatively significant risk of minor complications particularly in the coverage of chronic wounds, our study supports their utility in both the acute and reconstructive phases of burn care.

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

“…25,29 Although perforator-pedicled propeller flaps have become increasingly popular in recent decades, their use in acute trauma setting has not been reported in literature so far, unless in immediate burn care with low numerosity of cases. 32 Some authors state that it is not advisable to rotate flaps within a significant zone of injury, as this might carry significant risk of flap necrosis and failure. 8 In this article, we aim to preliminarily revise and present our series of propeller flaps for small-to medium-size soft tissue defects in exposed lower limb fractures Gustilo IIIB.…”

Surgical treatment algorithms for post-burn contractures

“…The versatility and safety of local flaps has been improved by incorporating perforator vessels, because the vascular supply is secured and perforators are located in throughout the body. Perforator-based propeller flaps and so-called ad hoc perforator-based flaps provide well-vascularized skin and soft tissue which has reliable pliability [20, 21]. As the multicenter randomized study excluded scars of the face and scalp, it seems that these methods are especially effective in reconstruction of burn contracture of extremities and trunk to preserve ROM across joints.…”