Freestyle perforator‐based propeller flap of medial arm for medial elbow reconstruction

Abstract

Elbow reconstruction is challenging for reconstructive surgeons. The purpose of this report is to present the results of the use of freestyle perforator-based propeller flap designed from the medial arm region for elbow reconstruction. The defects following soft tissue sarcoma resection at the medial and posterior elbow were repaired in two patients. The dimensions of the defects were 11 × 7 cm(2) and 10 × 7 cm(2). Two perforators were identified in each case using Doppler ultrasound probe in the medial arm, adjacent to the defect. The perforator with visible pulsation was chosen as the pedicle vessel, which was 12-cm and 7-cm proximal to the medial epicondyle. An elliptical flap, extending almost the full length of arm, was raised and rotated 180° to repair medial elbow defects. The sizes of the flaps were 17 × 8 cm(2) and 11 × 7 cm(2). The donor sites were closed directly. Both flaps survived; temporary venous congestion occurred in one case. There were no other postoperative complications. These cases illustrated that the medial arm flap might be used for reconstruction of medial elbow defects with this freestyle perforator-based propeller flap design.

Medial elbow reconstruction with perforator based medial arm propeller flap

“…As the flap was planned to be narrow and this section was far from the perforator, skin necrosis occured. The medial elbow soft tissue defect was successfully reconstructed with this flap in our case as in the cases described by Zang et al [24].…”

“…In a patient in that study venous congestion which developed in the distal flap was associated with excessive tension over the pedicle and this was corrected by removing tension over the pedicle [24]. In the presented patient there was no tension over the pedicle, but venous congestion developed in the distal part of the flap in the early period and over time.…”

Risk Factor Analysis of Freestyle Propeller Flaps

“…In the past few decades, pedicled perforator propeller flaps combined with the freestyle concept have gained greater popularity, which has increased options for reconstructive surgeons. The propeller flaps have been widely used in upper and lower extremities reconstruction, 6,10,[18][19][20][21][22][23] and more recently in trunk reconstruction. 9,15,24-26 Likewise, we have applied freestyle propeller concept throughout the body, as shown in this series.…”

Propeller Flap in Patient with Ewing’s Sarcoma in Lower Limb: A Case Report Study

“…Similar case reported for anterior lateral thigh flap underwent wide-resection soft tissue sarcoma without skin grafting [5]. Also, reported cases of tumors resection then covered by propeller flap [6].…”