Free perforator flaps vs propeller flaps in lower limb reconstruction: A cost/effectiveness analysis on a series of 179 cases

Innocenti, Marco; Dell'Acqua, Irene; Famiglietti, Matteo; Vignini, Livia; Menichini, Giulio; Ghezzi, Serena

doi:10.1016/j.injury.2019.10.039

Cited by 14 publications

(37 citation statements)

References 36 publications

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“…22 Since rotation of the propeller flap is based on a single vascular pivot point, the perforator, there is no need for a microvascular anastomosis, thereby reducing both operating time and surgical risks. 23 In complex cases where secondary procedures are needed, like for staged tendon reconstruction, the use of a perforator flap will have a faster and more reliable neovascularization compared with a skin grafted muscle flap, which avoids the risk of delayed partial flap loss or wound breakdown following any flap reelevation.…”

Section: Discussionmentioning

confidence: 99%

Propeller Flaps in the Upper Extremity: Arm and Forearm Reconstruction

Malzone

Innocenti

2020

Semin Plast Surg

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The propeller flap is an island of skin that is raised on its pedicle (most commonly a single perforator) and can rotate 180 degrees to cover a soft tissue defect. Thanks to these features, the propeller flap brings reliable tissue from outside of the zone of injury while sparing the main vessels of the upper extremity. This technique limits the donor site to the same limb, captures skin characterized by having the same color and texture, does not necessarily need a microvascular anastomosis, and overall reduces the operating time and surgical cost. Our intent here is to present 27 cases with different soft tissue defects of the upper arm and forearm that have been successfully reconstructed using propeller flaps. The surgical technique, with emphasis on the anatomy of the upper arm, is described. In particular, use of a freestyle approach to customize a perforator-based propeller flap to cover defects from small to medium size is detailed. In our experience, the use of a perforator propeller flap in the upper extremity for resurfacing represents both a very reliable and aesthetically pleasant option.

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Section: Discussionmentioning

confidence: 99%

Propeller Flaps in the Upper Extremity: Arm and Forearm Reconstruction

Malzone

Innocenti

2020

Semin Plast Surg

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“…However, free flap transfer requires micro-anastomosis of the pedicle, which is a resourceintensive procedure and includes a risk of total flap loss. A PPP flap is regarded as a better alternative 1) instead, especially in cases with medium to small defects 5) . A PPP flap streamlines the need for micro-anastomosis, which is commonly difficult to perform in injured legs.…”

Section: Discussionmentioning

confidence: 99%

“…A PPP flap streamlines the need for micro-anastomosis, which is commonly difficult to perform in injured legs. Furthermore, reconstruction with a PPP flap meets the traditional "like with like" principle that recommends replacing the defect with a tissue of the same kind for aesthetically favorable results 6,7) and cost-effectiveness 5) .…”

Section: Discussionmentioning

confidence: 99%

Delayed Stepwise Rotation for the Salvage of a Congested Perforator-Pedicled Propeller Flap in Distal Lower Extremity with Severe Edema

Koimizu

Takatsuji

Numajiri

2020

International Journal of Surgical Wound Care

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A perforator-pedicled propeller (PPP) flap is often employed for reconstruction of the distal lower extremity. However, flap congestion that often causes flap necrosis occurs in the propeller flap. Although several procedures have been reported previously, a preferable method for preventing congestion and rescuing massive flap necrosis in PPP flap cases is undetermined. A healthy 41-year-old man who sustained a pilon fracture in his right leg required soft tissue reconstruction because of strong edema that did resolve even after a staged protocol. A PPP flap pedicled with a perforator from the posterior tibial artery was harvested and rotated 180° to cover the defect. After reconstructive surgery, the flap developed severe congestion indicating the possibility of near-total flap loss. The flap was rescued by rotating it back to where its perfusion was stable. It was then rotated again in stages into the targeted position every 2 to 3 days over a period of 7 days. The flap was rescued and the wound was healed. Delayed in-stage rotation of the flap was one of the options for salvaging a PPP flap from congestion especially in cases with severe soft tissue edema such as pilon fracture.

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“…After a long and important history in vascular anatomy research and flaps' surgery, the perforator flaps became the most used flaps in the 21st century 1–16 . The perforator flaps were extensively used initially as free perforator flaps 2,3,5,6,9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…The perforator flaps were extensively used initially as free perforator flaps 2,3,5,6,9,10 . The introduction of local perforator flaps can diminish the donor‐site morbidity significantly and the wound healing problems and can improve the aesthetic deformities and the functional outcome 1,4,7,8,11–16 . The local perforator flaps offer as main advantages the absence of sacrificing main arteries and muscles, the absence of microsurgery, shorter operation time, shorter hospitalisation time and less complications.…”

Section: Introductionmentioning

confidence: 99%

Minimising donor‐site morbidity following limbs' injuries with keystone perforator island flap reconstruction

Virág

Muntean

Georgescu

2022

Wound Repair Regeneration

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Plastic surgeons strive to choose better techniques to reconstruct the defects of the limbs, minimising the wound healing problems, improving the aesthetic and functional outcome with less complications. This study refers to the use of keystone perforator island flap (KPIF) in limbs' reconstruction, their harvesting technique to minimise donorsite morbidity, maximise the functional and cosmetic outcome, and will point on the most important indications and advantages. Between January 2014 and June 2020, a number of 28 cases were treated in our department, with simple or complex defects of the limbs. The database included patients' demographics, comorbidities, aetiology, characteristics of the flap, surgical factors, follow-up period and flap outcomes. We performed 28 KPIFs, 14 of type I, 12 of type IIA, 1 of type III, and 1 of type IV, with an average size of 69 cm 2 (ranged from 1.25 cm 2 to 318 cm 2 ). Trauma was the major cause of the defects. One flap exhibited approximately 4% partial superficial necrosis.All donor sites healed without any adverse events. All patients were satisfied with the functional and aesthetic results. The KPIFs provide a simple and effective method of wound closure by using tissues of similar texture, thickness and colour. Preserving the main artery and the underlying muscle, this flap reduces the donor site morbidity. The use of KPIFs seems to be one of the most suitable choices whenever possible.

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Free perforator flaps vs propeller flaps in lower limb reconstruction: A cost/effectiveness analysis on a series of 179 cases

Cited by 14 publications

References 36 publications

Propeller Flaps in the Upper Extremity: Arm and Forearm Reconstruction

Propeller Flaps in the Upper Extremity: Arm and Forearm Reconstruction

Delayed Stepwise Rotation for the Salvage of a Congested Perforator-Pedicled Propeller Flap in Distal Lower Extremity with Severe Edema

Minimising donor‐site morbidity following limbs' injuries with keystone perforator island flap reconstruction

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