Direction of Flap Rotation in Propeller Flaps: Does It Really Matter?
28 December 2018
21 February 2019
10 May 2019 (online)
Background This article investigates the effect of 180° rotating propeller flaps and evaluates whether each flap has a “preferable” rotating direction.
Methods Part 1 evaluates the flap pedicle velocity and flow volume in neutral, 180°counterclockwise, and clockwise rotated position for 29 consecutive flaps. The data (velocity and volume) were divided into three groups: neutral, high value, and low value group then evaluated. Part 2 compares the outcome from the prospective study where a preferable rotation with high value was selected against 29 patients from 2012 to 2016 who had the same operation without selecting a preferable rotation direction.
Results In part 1, the three groups (neutral, high value, and low value groups) showed mean velocity of 28.06 ± 7.94, 31.92 ± 10.22, 24.41 ± 8.12 cm/s, respectively, and mean volume of 6.11 ± 4.95, 6.83 ± 6.69, 4.62 ± 3.55 mL/min, respectively. The mean velocity and volume of the perforator in the high value group were significantly higher than that in the low value group (p = 0.0001). In part 2, although no statistical significance in the outcome was observed, there were two cases of total, two cases of partial flap loss, and three cases of wound dehiscence in the patients where preferable rotations was not selected compared with only two wound dehiscence for flaps with preferable rotation.
Conclusion The velocity and flow of the flap are significantly different based on the rotation direction of the flap. Using the preferred rotation direction with statistically higher value of velocity and flow may increase the overall outcome of the propeller flap, especially where larger flaps are used.
- 1 Teo TC. The propeller flap concept. Clin Plast Surg 2010; 37 (04) 615-626 , vi
- 2 Yu S, Zang M, Xu L. , et al. Perforator propeller flap for oncologic reconstruction of soft tissue defects in trunk and extremities. Ann Plast Surg 2016; 77 (04) 456-463
- 3 Koshima I, Hosoda M, Inagawa K, Moriguchi T, Orita Y. Free medial thigh perforator-based flaps: new definition of the pedicle vessels and versatile application. Ann Plast Surg 1996; 37 (05) 507-515
- 4 Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991; 44 (01) 53-54
- 5 Hyakusoku H, Ogawa R, Oki K, Ishii N. The perforator pedicled propeller (PPP) flap method: report of two cases. J Nippon Med Sch 2007; 74 (05) 367-371
- 6 Hallock GG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg 2006; 56 (05) 540-542
- 7 Demir A, Acar M, Yldz L, Karacalar A. The effect of twisting on perforator flap viability: an experimental study in rats. Ann Plast Surg 2006; 56 (02) 186-189
- 8 Keleş MK, Demİr A, Küçüker I, Alici O. The effect of twisting on single and double based perforator flap viability: an experimental study in rats. Microsurgery 2014; 34 (06) 464-469
- 9 Chang CH, Lim SY, Pyon JK, Bang SI, Oh KS, Mun GH. The influence of pedicle length on the viability of twisted perforator flaps in rats. J Reconstr Microsurg 2009; 25 (09) 533-538
- 10 Gokrem S, Sarifakioğlu N, Toksoy K, Terzioğlu A, Aslan G. Effects of 360-degree pedicle torsion on island skin flaps: experimental study in rats. J Reconstr Microsurg 2005; 21 (05) 313-316
- 11 Bektas G, Ozkan O, Cinpolat A, Bassorgun IC, Ciftcioglu MA, Ozkan O. Comparing the effects of pedicle torsion on axial or perforator flaps; improving the perforator flap resistance to pedicle torsion with delay phenomenon. J Reconstr Microsurg 2014; 30 (08) 531-538
- 12 Schonauer F, La Rusca I, Di Monta G, Molea G. Choosing the correct sense of rotation in 180 degrees propeller flaps. J Plast Reconstr Aesthet Surg 2008; 61 (12) 1492
- 13 Schonauer F, Moio M, La Padula S, Molea G. Use of preoperative Doppler for distally based sural flap planning. Plast Reconstr Surg 2009; 123 (05) 1639-1640 , author reply 1640
- 14 Eom JS, Hong JP. Lower back defect coverage using a free-style gluteal perforator flap. Ann Plast Surg 2011; 67 (05) 516-519
- 15 Hong JPJ, Choi D, Lee Y, Kim Y, Jang M, Peter Suh H. Using the gluteal artery perforator flap to reconstruct sacral sore. Plast Reconstr Surg Glob Open 2017; 5 (06) e1368
- 16 Park SW, Oh TS, Eom JS, Sun YC, Suh HS, Hong JP. Freestyle multiple propeller flap reconstruction (jigsaw puzzle approach) for complicated back defects. J Reconstr Microsurg 2015; 31 (04) 261-267
- 17 Nelson JA, Fischer JP, Brazio PS, Kovach SJ, Rosson GD, Rad AN. A review of propeller flaps for distal lower extremity soft tissue reconstruction: is flap loss too high?. Microsurgery 2013; 33 (07) 578-586
- 18 Sisti A, D'Aniello C, Fortezza L. , et al. Propeller flaps: a literature review. In Vivo 2016; 30 (04) 351-373
- 19 Mohan AT, Sur YJ, Zhu L. , et al. The concepts of propeller, perforator, keystone, and other local flaps and their role in the evolution of reconstruction. Plast Reconstr Surg 2016; 138 (04) 710e-729e
- 20 Vitse J, Bekara F, Bertheuil N, Sinna R, Chaput B, Herlin C. Perforator-based propeller flaps reliability in upper extremity soft tissue reconstruction: a systematic review. J Hand Surg Eur Vol 2017; 42 (02) 157-164
- 21 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
- 22 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141
- 23 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124 (05) 1529-1544
- 24 Lecours C, Saint-Cyr M, Wong C. , et al. Freestyle pedicle perforator flaps: clinical results and vascular anatomy. Plast Reconstr Surg 2010; 126 (05) 1589-1603
- 25 Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114 (04) 910-916
- 26 Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg 2009; 124 (6, Suppl): e419-e426
- 27 Geis S, Prantl L, Dolderer J, Lamby P, Mueller S, Jung EM. Postoperative monitoring of local and free flaps with contrast-enhanced ultrasound (CEUS)--analysis of 112 patients. Ultraschall Med 2013; 34 (06) 550-558
- 28 Cajozzo M, Toia F, Innocenti A. , et al. Retrospective analysis in lower limb reconstruction: propeller perforator flaps versus free flaps. J Reconstr Microsurg 2017; 33 (S 01): S34-S39
- 29 Chaput B, Bertheuil N, Carloni R, Bekara F, Laloze J, Herlin C. Propeller perforator flaps of extremities seem less reliable. J Reconstr Microsurg 2017; 33 (08) 603-604
- 30 Paik JM, Pyon JK. Risk factor analysis of freestyle propeller flaps. J Reconstr Microsurg 2017; 33 (01) 26-31
- 31 Hanasono MM, Ogunleye O, Yang JS, Hartley CJ, Miller MJ. Changes in blood velocity following microvascular free tissue transfer. J Reconstr Microsurg 2009; 25 (07) 417-424