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The Propeller Concept Applied to Free Flaps and the Proposal of a “Clock Flap” Nomenclature
23 May 2017
11 July 2017
25 August 2017 (online)
Background It is a common experience for reconstructive surgeons to feel the necessity for large flaps and minimal donor-site morbidity at the same time. In the reported cases where we felt this call intraoperatively, we have met our need by applying the “propeller concept” to fasciocutaneous or composite flaps, separating and rotating its different tissue components.
Methods We present a series of five cases in which we separated and rotated diversely fascial and cutaneous components of free perforator flaps to enhance the extension of the flap or to tailor it better on the tissue gap for optimal functional and aesthetic results. We also propose a simple nomenclature system for rotation angles' definition, summarized as the “clock flap” classification, where the different components of the flap represent the arms of a clock which has the main vessel axis on the 12–6 line.
Results All reconstructive procedures succeeded with only minor complications. No partial failure due to vessel rotations was noticed.
Conclusion Applying “propeller style” rotations to different components of free flaps seems to be a safe procedure which may help maximize flap performance in terms of coverage of the recipient site, while minimizing scars and impairment of the donor site. Also, the proposed nomenclature gives the opportunity to record and compare surgical procedures for statistical analysis.
- 1 Teo TC. The propeller flap concept. Clin Plast Surg 2010; 37 (04) 615-626 , vi
- 2 Tos P, Innocenti M, Artiaco S. , et al. Perforator-based propeller flaps treating loss of substance in the lower limb. J Orthop Traumatol 2011; 12 (02) 93-99
- 3 Bravo FG, Schwarze HP. Free-style local perforator flaps: concept and classification system. J Plast Reconstr Aesthet Surg 2009; 62 (05) 602-608 , discussion 609
- 4 Cadenelli P, Bordoni D, Radaelli S, Marchesi A. Proximally based anterolateral-thigh (ALT) flap for knee reconstruction: an advancement propeller perforator flap. Aesthetic Plast Surg 2015; 39 (05) 752-756
- 5 Artiaco S, Battiston B, Colzani G. , et al. Perforator based propeller flaps in limb reconstructive surgery: clinical application and literature review. BioMed Res Int 2014; 2014: 690649
- 6 D'Arpa S, Toia F, Pirrello R, Moschella F, Cordova A. Propeller flaps: a review of indications, technique, and results. BioMed Res Int 2014; 2014: 986829
- 7 D'Arpa S, Cordova A, Pignatti M, Moschella F. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg 2011; 128 (04) 892-906
- 8 Cavadas PC, Teran-Saavedra PP. Combined latissimus dorsi-thoracodorsal artery perforator free flap: the “razor flap”. J Reconstr Microsurg 2002; 18 (01) 29-31
- 9 Innocenti M, Cardin-Langlois E, Menichini G, Baldrighi C. Gastrocnaemius-propeller extended miocutanous flap: a new chimaeric flap for soft tissue reconstruction of the knee. J Plast Reconstr Aesthet Surg 2014; 67 (02) 244-251
- 10 Zhang YX, Hayakawa TJ, Levin LS, Hallock GG, Lazzeri D. The economy in autologous tissue transfer: part 1. The kiss flap technique. Plast Reconstr Surg 2016; 137 (03) 1018-1030
- 11 Mahajan AL, Van Waes C, D'Arpa S. , et al. Bipedicled DIEAP flaps for reconstruction of limb soft tissue defects in male patients. J Plast Reconstr Aesthet Surg 2016; 69 (07) 920-927
- 12 Paik JM, Pyon JK. Risk factor analysis of freestyle propeller flaps. J Reconstr Microsurg 2017; 33 (01) 26-31
- 13 Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction?. Clin Orthop Relat Res 2014; 472 (07) 2276-2286
- 14 Gir P, Cheng A, Oni G, Mojallal A, Saint-Cyr M. Pedicled-perforator (propeller) flaps in lower extremity defects: a systematic review. J Reconstr Microsurg 2012; 28 (09) 595-601
- 15 Townley WA, Royston EC, Karmiris N, Crick A, Dunn RL. Critical assessment of the anterolateral thigh flap donor site. J Plast Reconstr Aesthet Surg 2011; 64 (12) 1621-1626
- 16 Bhadkamkar MA, Wolfswinkel EM, Hatef DA. , et al. The ultra-thin, fascia-only anterolateral thigh flap. J Reconstr Microsurg 2014; 30 (09) 599-606