Clinical Applications of Perforator-Based Propeller Flaps in Upper Limb Soft Tissue Reconstruction

Ono, Shimpei; Sebastin, Sandeep J.; Yazaki, Naoya; Hyakusoku, Hiko; Chung, Kevin C.

doi:10.1016/j.jhsa.2010.12.021

Cited by 69 publications

(75 citation statements)

References 56 publications

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“…The large blade of the propeller flap is designed slightly longer than the distance between the pivot point of the flap and the furthest part of the defect. 22 The adequate flap length can avoid the aggressive retrograde dissection of the perforator. In addition, the design of propeller flap uses a bridge segment of flap to cover the widest portion of the donor site, making the closure much easier.…”

Section: Discussionmentioning

confidence: 99%

Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection

Zang

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Section: Discussionmentioning

confidence: 99%

Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection

Zang

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…[1] Early description of propeller flaps mentioned of a thick subcutaneous pedicle which restricted the arc of rotation of these flaps. With increasing knowledge and awareness of the location and the vascular territory perfused by cutaneous perforators, it is now possible to design propeller flaps based on a single perforator, so-called “perforator based propeller flaps.” These flaps permit flap rotation up to 180°.…”

Section: Introductionmentioning

confidence: 99%

Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

Panse¹,

Sahasrabudhe²

2014

Indian J Plast Surg

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Background:The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent.Materials and Methods:We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series.Results:63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap.Conclusion:Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects.Level of Evidence:Therapeutic IV.

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“…Yet, the application of perforator-based propeller flaps to upper-extremity reconstruction is still limited [6]. Anatomic variations of the perforators encountered during surgery are one of the reasons that limit frequent use of perforator flaps, in upper-extremity.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of elbow defect with radial collateral artery perforator flap

Dağdelen¹

2017

Hand Microsurg

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Background: Distal fingertip amputations with exposed bone is challenging for the surgeon to manage. In order to reconstruct a good sensate pulp with appropriate closure, various flaps are advocated in the literature. Of these, palmar advancement flap, first described by Moberg in 1964, comprises one of the most popular options. Methods: Thirteen patients (11 male, 3 female) with fingertip injuries were operated. Following the elevation of Moberg flap, proposed modifications were carried out. Joint mobility and pulp sensitivity were recorded as well and advancement scores were noted before and after the modification. These scores were assessed statistically. Results: No complications were noted and there was no need for additional surgery. Excellent joint mobility and pulp sensitivity were maintained. This modification showed a statistically significant improvement in the advancement (p<0.05). Conclusions: Moberg flap is a good option for the closure of fingertip defects. Some simple modifications, as described in here, can enhance the advancement while securing the entire advantages of the flap. IntroductionThe hand is a unique part in the body in and plays important and often irreplaceable functions. In the industrialized world, occupational hand injuries need to be healed as soon as possible. Meanwhile, several healing techniques with various options are being applied to hundreds of thousands of patients by experienced practitioners.Unlike other hand injuries, fingertip amputations need additional attention in order to establish a normal pulp sensibility and maximum range of motion, and like others to maintain the upmost level of hand functioning.In 1964, the volar advancement flap was first described by Moberg for the reconstruction of pulp defects of the thumb (1). This flap is a pedicled advancement flap proximally based on an intact skin pedicle including both neurovascular bundles. This technique establishes a successful neurosensation of the pulp with a limited advancement as well. However, a simple modification as described here, and never been reported elsewhere, can enhance additional advancement. Patients and MethodsThe study was performed with informed consents obtained from all participants.Technique Thirteen patients (11 males, 3 females) with fingertip injuries were operated under regional anaesthesia. Palmar advancement flap was raised over the parathenon (1) (Figure 1a). Both neurovascular bundles were included in the flap so that neurosensible coverage is accomplished (Figure 1b). To increase the Hand Microsurgery & ABSTRACTElbow defects form a challanging subgroup to reconstruct among upper extremity defects. We aimed to present a succesful case of elbow defect reconstructed by a Radial Collateral Artery Perforator Flap (RCAPF), also to discuss the advantages and applicability of this flap in light of current literature.

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Clinical Applications of Perforator-Based Propeller Flaps in Upper Limb Soft Tissue Reconstruction

Cited by 69 publications

References 56 publications

Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection

Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection

Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

Reconstruction of elbow defect with radial collateral artery perforator flap

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