Propeller Flaps in the Upper Extremity: Arm and Forearm Reconstruction

Malzone, Gerardo; Innocenti, Marco

doi:10.1055/s-0040-1715153

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…This research gap may be due to the challenge that upper extremity reconstruction results in shorter pedicle lengths in comparison to the lower extremity, and thus they are less utilized. 35 A systematic review and metaanalysis of 428 perforator-pedicled propeller flaps in lower extremity defects by Bekara et al reported a complication rate of 25.2% (n ¼ 108) and flap survival rate of 84.3% (n ¼ 361). 36 It appears PPFs used in upper extremity reconstruction have overall lower complication rates and better survival as seen in our findings and those of Lazzeri et al 9 When compared with reports on PPFs of the upper extremity more broadly, hand and digital PPFs appear to have a slightly higher complication rate and flap failure rate.…”

Section: Discussionmentioning

confidence: 99%

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Bovill

Huffman

Cach

et al. 2024

Journal of Hand and Microsurgery

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Background Propeller perforator flaps (PPFs) have increased in popularity due to the freedom in design and ability to cover a variety of defects without sacrificing the major vessels. Present reports of PPFs for upper limb reconstruction have not provided guidance for hand reconstruction, specifically. This study aims to review the current literature and evaluate techniques for use of PPFs in hand reconstruction. Methods A comprehensive literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published from 1991 to 2021. The database search was queried for records using appropriate Medical Subject Headings (MeSH) terms. Studies reporting PPFs were limited to English language and excluded lower extremity or upper extremity reconstruction not specific to defects in the hand or digits. Study characteristics, patient demographics, indications, preoperative testing, flap characteristics, flap survival, and complication rates were collected. Results Out of the initial 1,348 citations yielded, 71 underwent full-text review. Ultimately, 25 unique citations were included encompassing 12 retrospective reviews (48%), 3 prospective cohort studies (10%), and 10 case series (40%). In review, 525 patients underwent reconstruction with a total of 613 propeller flaps performed to repair defects of the hand, digits, or both with use of 18 unique flap types. Overall flap survival was 97.8%. Acute wounds accounted for 72.9% of performed reconstructions. The mean flap coverage was 14.7 cm2. Complications occurred in 19.8% of cases, with venous congestion and partial flap necrosis occurring in 5.5 and 6.5% of cases, respectively, leading to a flap failure rate of 2.1%. Conclusion PPFs are a reliable option for hand or digital reconstruction, allowing surgeons to cover a variety of defects without sacrificing local vasculature. Despite nearly a 20% reported complication rate, nearly all flaps with venous congestion and partial flap necrosis included in these articles resolved without the need for secondary intervention, retaining an excellent overall flap survival.

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Section: Discussionmentioning

confidence: 99%

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Bovill

Huffman

Cach

et al. 2024

Journal of Hand and Microsurgery

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“…As reported by Inoue and Taylor, 10 it is safer to include perforators from a radial and ulnar recurrent artery to stabilize blood flow near the cubital fossa. To do so, we included superficial flexor muscles to the flap, and it is possible to easily incorporate musculocutaneous perforators of ulnar and radial arteries 10–13 …”

Section: Discussionmentioning

confidence: 99%

“…To do so, we included superficial flexor muscles to the flap, and it is possible to easily incorporate musculocutaneous perforators of ulnar and radial arteries. [10][11][12][13] Some have also suggested that the postoperative contour of the shoulder is better to fit a prosthesis if the flap has a volume of flexor muscle groups. 2,14 Concerning the size of the flap that can be harvested, Kimura et al 11 reported that the average length of the forearm from the volar aspect of the pisiform bone to the medial epicondyle of the humerus was 22.8 cm.…”

Section: Discussionmentioning

confidence: 99%

Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma

et al. 2023

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Reconstruction after radical forequarter amputation for recurrent proximal extremity sarcoma is challenging because the defect is significant, and the axillary or subclavian vessels are resected with the tumor, indicating that the pedicle of nearby flaps is often cut off. Free flaps are commonly used to cover the defect, but the donor site morbidity is problematic. Another problem with resecting the axillary or subclavian vessels is difficulty obtaining recipient vessels with matching calibers for another free flap. The authors presented 2 cases that successfully solved all these problems by covering the defects by the forearm fillet flaps.The forearm fillet flap has the advantage of using a portion that is usually discarded, so there is no donor site morbidity. Moreover, using the brachial artery as the pedicle of the flap allows the anastomosis to the stump of the resected axillary or subclavian artery because differences in caliber are slight.The use of the forearm fillet flaps has been reported less frequently than the fillet flaps in the lower extremities, and most cases are posttraumatic. In cases of trauma, complications are reported to occur in about 1 in 4 patients, but in cases after tumor resection, ischemic time can be controlled, and there are no risks of contamination or unnoticed forearm damage, so more stable results can be expected as in this report.Using the free flap from the distal portion of the resected upper limb, especially in cases with a short prognosis, is a viable option that effectively minimizes damage to the donor site and maintains quality of life.

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“…A perforator-pedicled propeller flap (PPPF) is a versatile technique with many benefits, such as adequate blood supply, like-with-like repair, minimal donor site morbidity, and no extra intraoperative patient's position alteration (4)(5)(6). Given the abundance of musculocutaneous perforators for the overlying skin in trunks and extremities, PPPFs serve as a primary workhorse for treating the defects caused by wide resection of tumors in these regions (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

A three-dimensional visualization of the full-field surgical region based on thin-slice MRI: A helpful approach for simultaneously guiding tumor resection and perforator flap elevation

et al. 2022

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BackgroundThe goal of the current study was to explore the application of preoperative three-dimensional reconstruction (3DR) based on thin-slice magnetic resonance imaging (MRI) in the simultaneous guidance of en bloc tumor resection and adjacent perforator flap elevation.MethodsThe prospective cohort included 35 patients diagnosed with either soft tissue sarcoma or squamous cell skin cancer between 2019 and 2021. The preoperative 3DR based on thin-slice MRI illustrated the spatial anatomical relationship among the tumor, underlying muscle, adjacent perforator vessels, and bone around the surgical region. The accuracy of preoperative imaging data was verified by intraoperative vessel dissection and postoperative pathological measurements.ResultsTumor size from 3DR data showed relatively high concordance rates with pathological measurements within the 95% limits of agreement. An average of three perforators (range: 1–7) with a mean diameter of 0.32 cm (range: 0.18–0.74 cm) from the 3DR were present in our study. The average distance between tumor boundary and perforator piercing sites on the 3DR was 2.2 cm (range: 1.2–7.7 cm). The average length of artery perforator coursing along the subcutaneous tissue was 5.8 cm (range: 3.3–25.1 cm). The mean flap harvest time was 55 mins (range: 36–97 min). The average flap size was 92.2 cm2 (range: 32–126 cm2). One perforator flap occurred distal partial necrosis.ConclusionA thorough understanding of anatomical structures in the surgical region according to full-field 3DR based on thin-slice MRI can improve the performance of radical resection of the tumor and adjacent perforator flap transfer, especially for junior surgeons with a poor experience.

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Propeller Flaps in the Upper Extremity: Arm and Forearm Reconstruction

Cited by 6 publications

References 23 publications

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Propeller Perforator Flaps Used for Hand and Digit Reconstruction: A Systematic Review

Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma

A three-dimensional visualization of the full-field surgical region based on thin-slice MRI: A helpful approach for simultaneously guiding tumor resection and perforator flap elevation

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