PDF herunterladen
Semin Plast Surg 2020; 34(03): 152-160
DOI: 10.1055/s-0040-1714271
Review Article

How to Design and Harvest a Propeller Flap

Marco Pignatti
1   Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Italy
,
Valentina Pinto
2   Department of Plastic Surgery, Policlinico di Sant'Orsola - Bologna, Italy
,
Ann-Charlott Docherty Skogh
3   Department of Surgery, Breast Cancer Center, South General Hospital, Stockholm, Sweden and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
,
Federico Armando Giorgini
2   Department of Plastic Surgery, Policlinico di Sant'Orsola - Bologna, Italy
4   Department of Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
,
Riccardo Cipriani
2   Department of Plastic Surgery, Policlinico di Sant'Orsola - Bologna, Italy
,
Giorgio De Santis
4   Department of Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
,
Geoffrey G. Hallock
5   Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Propeller flaps are local flaps based either on a subcutaneous pedicle, a single perforator, or vessels entering the flap in such a way so as to allow the flap to rotate on their axis. Depending on the kind of pedicle and the anatomical area, the preoperative investigation and the harvesting techniques may vary.

An adequate knowledge of skin and subcutaneous tissue perfusion in the different areas of the body is very important to plan a propeller flap to be successful.

The surgeon should begin by finding the most suitable perforators in the area surrounding the defect using available technology. The position, size, and shape of the flap are planned about this point.

For perforator-pedicled propeller flaps, the procedure starts with an exploration from the margins of the defect or through a dedicated incision to visualize any perforators in the surroundings. The most suitable perforator is selected and isolated, the skin island is replanned, and the flap is harvested and rotated into the defect. The variations in surgical technique for other types of propellers and in specific anatomical areas are also described.

Compared with free flaps, propeller flaps have the advantage of a simpler, shorter operation, without the need for a recipient vessel for microanastomosis.

Yet, from a technical point of view, an adequate experience in dissecting perforators and the use of magnifying glasses are almost always required.

Keywords

propeller flap - technique - propeller harvesting - propeller planning


Publikationsverlauf

Artikel online veröffentlicht:
22. September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Asko Seljavaara S. Free style free flaps. Paper presented at: Seventh Congress of the International Society of Reconstructive Microsurgery; June 19–30, 1983; New York, NY
    PubMedGoogle Scholar
  • 2 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
    CrossrefPubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 Pignatti M, Ogawa R, Mateev M. , et al. Our definition of propeller flaps and their classification. Semin Plast Surg 2020; 34 (03) 139-144
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 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
    CrossrefPubMedGoogle Scholar
  • 6 Mardini S, Al-Mufarrej FM, Jeng SF, Wei FC. Free-style free flaps. In: Blondeel PN, Morris SF, Hallock GG, Neligan PC. , eds. Perforator Flaps: Anatomy, Technique, & Clinical Applications. Vol. 2. 2nd ed. St. Louis, MO: Quality Medical; 2013: 1245-1260
    Google Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 Pignatti M, Tos P, Garusi C. , et al. A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery. Injury 2020; (epub ahead of print) DOI: 10.1016/j.injury.2020.02.006.
    CrossrefPubMedGoogle Scholar
  • 9 Rozen WM, Pan WR, Le Roux CM, Taylor GI, Ashton MW. The venous anatomy of the anterior abdominal wall: an anatomical and clinical study. Plast Reconstr Surg 2009; 124 (03) 848-853
    CrossrefPubMedGoogle Scholar
  • 10 Taylor GI, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg 1990; 43 (01) 1-16
    CrossrefPubMedGoogle Scholar
  • 11 Smit JM, Klein S, Werker PM. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesthet Surg 2010; 63 (09) e674-e682
    CrossrefPubMedGoogle Scholar
  • 12 Stekelenburg CM, Sonneveld PM, Bouman MB. , et al. The hand held Doppler device for the detection of perforators in reconstructive surgery: what you hear is not always what you get. Burns 2014; 40 (08) 1702-1706
    CrossrefPubMedGoogle Scholar
  • 13 Kehrer A, Heidekrueger PI, Lonic D. , et al. High-resolution ultrasound-guided perforator mapping and characterization by the microsurgeon in lower limb reconstruction. J Reconstr Microsurg 2020; (e-pub ahead of print) DOI: 10.1055/s-0040-1702162.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Homsy C, McCarthy ME, Lim S, Lindsey Jr JT, Sands TT, Lindsey Sr JT. Portable Color-Flow Ultrasound Facilitates Precision Flap Planning and Perforator Selection in Reconstructive Plastic Surgery. Ann Plast Surg 2020; 84 (6S, Suppl 5): S424-S430
    CrossrefPubMedGoogle Scholar
  • 15 Miller JP, Carney MJ, Lim S, Lindsey JT. Ultrasound and plastic surgery: clinical applications of the newest technology. Ann Plast Surg 2018; 80 (6S, Suppl 6): S356-S361
    CrossrefPubMedGoogle Scholar
  • 16 Theuvenet WJ, Koeyers GF, Borghouts MH. Thermographic assessment of perforating arteries. A preoperative screening method for fasciocutaneous and musculocutaneous flaps. Scand J Plast Reconstr Surg 1986; 20 (01) 25-29
    CrossrefPubMedGoogle Scholar
  • 17 Weum S, Mercer JB, de Weerd L. Evaluation of dynamic infrared thermography as an alternative to CT angiography for perforator mapping in breast reconstruction: a clinical study. BMC Med Imaging 2016; 16 (01) 43
    CrossrefPubMedGoogle Scholar
  • 18 Hallock GG. Smartphone thermal imaging can enable the safer use of propeller flaps. Semin Plast Surg 2020; 34 (03) 161-164
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 19 Pereira N, Hallock GG. Smartphone thermography for lower extremity local flap perforator mapping. J Reconstr Microsurg 2020; (e-pub ahead of print) DOI: 10.1055/s-0039-3402032.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 20 Davis CR, Jones L, Tillett RL, Richards H, Wilson SM. Predicting venous congestion before DIEP breast reconstruction by identifying atypical venous connections on preoperative CTA imaging. Microsurgery 2019; 39 (01) 24-31
    CrossrefPubMedGoogle Scholar
  • 21 Rozen WM, Ashton MW. The venous anatomy of the abdominal wall for deep inferior epigastric artery (DIEP) flaps in breast reconstruction. Gland Surg 2012; 1 (02) 92-110
    PubMedGoogle Scholar
  • 22 Schaverien MV, Ludman CN, Neil-Dwyer J. , et al. Relationship between venous congestion and intraflap venous anatomy in DIEP flaps using contrast-enhanced magnetic resonance angiography. Plast Reconstr Surg 2010; 126 (02) 385-392
    CrossrefPubMedGoogle Scholar
  • 23 Ono S, Ohi H, Ogawa R. Imaging in propeller flap surgery. Semin Plast Surg 2020; 34 (03) 145-151
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 24 Burnier P, Niddam J, Bosc R, Hersant B, Meningaud JP. Indocyanine green applications in plastic surgery: a review of the literature. J Plast Reconstr Aesthet Surg 2017; 70 (06) 814-827
    CrossrefPubMedGoogle Scholar
  • 25 Hashimoto I, Abe Y, Nakanishi H. The internal pudendal artery perforator flap: free-style pedicle perforator flaps for vulva, vagina, and buttock reconstruction. Plast Reconstr Surg 2014; 133 (04) 924-933
    CrossrefPubMedGoogle Scholar
  • 26 Hofer SO, Posch NA, Smit X. The facial artery perforator flap for reconstruction of perioral defects. Plast Reconstr Surg 2005; 115 (04) 996-1003 , discussion 1004–1005
    CrossrefPubMedGoogle Scholar
  • 27 Cordova A, Toia F, D'Arpa S, Giunta G, Moschella F. A new mucosal propeller flap (deep lingual artery axial propeller): the renaissance of lingual flaps. Plast Reconstr Surg 2015; 135 (03) 584e-594e
    CrossrefPubMedGoogle Scholar
  • 28 Cordova A, D'Arpa S, Rosatti F. , et al. Propeller flaps in the head and neck. Semin Plast Surg 2020; 34 (03) 165-170
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 29 Meyerson J, O'Brien A, Calvin N, Chandawarkar R. A new propeller trapezius muscle flap for reconstruction of posterior trunk defects: an anatomic study and report of three cases. Microsurgery 2019; 39 (05) 428-433
    CrossrefPubMedGoogle Scholar
  • 30 Hallock GG. The chimeric propeller flap. Semin Plast Surg 2020; 34 (03) 207-209
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Cajozzo M, Jiga L, Jandali Z. , et al. Complications and solutions in propeller flaps surgery. Semin Plast Surg 2020; 34 (03) 210-220
    Artikel in Thieme ConnectPubMedGoogle Scholar