Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

Abstract

BackgroundThe aim of this investigation was to systematically review the current literature to provide the best data for indications, outcomes, survival, and complication rates of pedicled propeller perforator flaps for upper body defects.MethodsA comprehensive literature review for articles published from January 1991 to December 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articles without available full-text, single case reports or papers with excessive missing data were excluded. Papers reporting pedicle-perforator (propeller) flaps used for lower extremity reconstruction were excluded from meta-analysis.ResultsFrom the initial 1,736 studies our search yielded, 343 studies qualified for the second stage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusion and exclusion criteria. Of the selected 41 articles, 26 were case series, original papers or retrospective reviews and were included, whereas 15 were case report papers and therefore were excluded. Two hundred ninety-five propeller flaps were reported to have been used in a total of 283 patients. Indications include repair of trauma-induced injuries, post-trauma revision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with a major complication rate (3.3%) comparable to that of free flaps. No specific exclusion criteria for the procedure were presented in the studies reviewed.ConclusionsPedicled propeller flaps are a versatile and safe reconstructive option that are easy and quick to raise and that provide unlimited clinical solutions because of the theoretical possibility of harvesting them based on any perforator chosen among those classified in the body.

Use of Perforator-Based Fasciocutaneous Flaps for Pressure Sore Reconstruction: Single-Perforator-Based Versus Multiple-Perforator-Based Flaps

“…Regarding pedicle flaps, Innocenti et al [42] studied the risk factors for complications with the use of propeller flaps in lower extremity reconstruction and found no specific risk factors for complications; however, there are potential risk factors for complications with the use of perforator-based fasciocutaneous flaps. In Lazzeri et al's [43] review, propeller perforator flaps for trunk and upper limb reconstruction resulted in the total complication rate of approximately 13.8 %, with a major complication rate of 3.4 %. However, the complication rate is higher in the lower extremities than in the other parts of the body, with frequent venous congestion and partial flap necrosis, and the total flap failure rate has been reported to be 1.1-5.6 % in the lower extremities [42,44,45].…”

Closure of Complex Posterior Midline Defects After Spinal Surgery With Sensate Midline-based Perforator Flaps and the Long-term Results

“…31 The perforator propeller flap is a flap designed with a skin island made of 2 paddles, 1 larger and 1 smaller, separated by the nourishing perforating vessel that corresponds to the pivot point. 32 The 2 portions of the skin island can rotate around the pedicle, like the propeller blades around the hub. The MDICAP flap differs from other perforator propeller flaps used for closure of trunk and back defects.…”

“…The MDICAP flap differs from other perforator propeller flaps used for closure of trunk and back defects. 32,33 The MDICAP flap has only 1 blade that rotates at its pivot point, the medial dorsal intercostal perforator, a defined anatomical structure located close to the midline. 11,34 The MDICAP flap can be harvested as a sensate flap and rotates easily into the midline defect.…”

Perineal Perforator–Based Island Flaps

“…In previous versions of the perforator flap, the source vessel on which the perforator arises has to be known and identified intraoperatively. 11,12 This was done as a safety measure for the flap harvest, but it required tedious intermuscular or intramuscular dissection to the source vessel. In perforator-based island flaps, there is no need to identify the source vessel, and it is possible to raise the flap safely and reliably in the "perforator-rich" areas of the body, such as the facial, perineal, gluteal, and peri-umbilical regions.…”