Propeller Flaps in the Posterior Trunk

Daniel J Kedar; Changsik John Pak; Hyunsuk Peter Suh; Joon Pio Hong

doi:10.1055/s-0040-1714086

Seminars in Plastic Surgery, Inhaltsverzeichnis

Semin Plast Surg 2020; 34(03): 176-183
DOI: 10.1055/s-0040-1714086

Review Article

Propeller Flaps in the Posterior Trunk

Daniel J Kedar

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

,

Changsik John Pak

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

,

Hyunsuk Peter Suh

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

,

Joon Pio Hong

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

› Institutsangaben

Abstract

The reconstruction of complex posterior trunk defects remains challenging. But now with an increased knowledge of angiosomes and the practice of perforator flaps, the posterior trunk offers a new plethora of options for reconstruction. Propeller flaps based on such perforator(s) offer an elegant solution for managing defects while achieving primary donor-site closure without significant morbidity. We will discuss the relevant anatomy and design principles for propeller flaps based on a review of the literature and our experience. Steps beginning with preoperative planning, perforator selection, and intraoperative surgical technique will be discussed, together with pearls on both avoiding and managing complications.

Keywords

posterior trunk reconstruction - propeller flap - perforator flap

Volltext

Referenzen

References
1 Bostwick III J, Scheflan M, Nahai F, Jurkiewicz MJ. The “reverse” latissimus dorsi muscle and musculocutaneous flap: anatomical and clinical considerations. Plast Reconstr Surg 1980; 65 (04) 395-399
2 Casas LA, Lewis Jr VL. A reliable approach to the closure of large acquired midline defects of the back. Plast Reconstr Surg 1989; 84 (04) 632-641
3 Mericli AF, Tarola NA, Moore Jr JH, Copit SE, Fox IV JW, Tuma GA. Paraspinous muscle flap reconstruction of complex midline back wounds: Risk factors and postreconstruction complications. Ann Plast Surg 2010; 65 (02) 219-224
4 Mathes DW, Thornton JF, Rohrich RJ. Management of posterior trunk defects. Plast Reconstr Surg 2006; 118 (03) 73e-83e
5 Few JW, Marcus JR, Lee MJ, Ondra S, Dumanian GA. Treatment of hostile midline back wounds: an extreme approach. Plast Reconstr Surg 2000; 105 (07) 2448-2451
6 Lin CH, Mardini S, Lin YT, Yeh JT, Wei FC, Chen HC. Sixty-five clinical cases of free tissue transfer using long arteriovenous fistulas or vein grafts. J Trauma 2004; 56 (05) 1107-1117
7 Oh TS, Hallock G, Hong JP. Freestyle propeller flaps to reconstruct defects of the posterior trunk: a simple approach to a difficult problem. Ann Plast Surg 2012; 68 (01) 79-82
8 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
9 Kato H, Hasegawa M, Takada T, Torii S. The lumbar artery perforator based island flap: anatomical study and case reports. Br J Plast Surg 1999; 52 (07) 541-546
10 Roche NA, Van Landuyt K, Blondeel PN, Matton G, Monstrey SJ. The use of pedicled perforator flaps for reconstruction of lumbosacral defects. Ann Plast Surg 2000; 45 (01) 7-14
11 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
12 Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991; 44 (01) 53-54
13 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
14 Katsaros J. Use of the island tensor fasciae latae flap to cover a chest-wall defect. Plast Reconstr Surg 1982; 69 (06) 1007-1009
15 Teo TC. The propeller flap concept. Clin Plast Surg 2010; 37 (04) 615-626 , vivi.
16 Pignatti M, Ogawa R, Hallock GG. , et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg 2011; 127 (02) 716-722
17 Blondeel PN, Van Landuyt KH, Monstrey SJ. , et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112 (05) 1378-1383 , quiz 1383, 1516, discussion 1384–1387
18 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
19 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
20 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
21 Prasad V, Morris SF. Propeller DICAP flap for a large defect on the back-case report and review of the literature. Microsurgery 2012; 32 (08) 617-621
22 Aho JM, Laungani AT, Herbig KS, Wong C, Kirchoff RW, Saint-Cyr M. Lumbar and thoracic perforators: vascular anatomy and clinical implications. Plast Reconstr Surg 2014; 134 (04) 635e-645e
23 Ogawa R, Murakami M, Vinh VQ, Hyakusoku H. Clinical and anatomical study of superficial cervical artery flaps: retrospective study of reconstructions with 41 flaps and the feasibility of harvesting them as perforator flaps. Plast Reconstr Surg 2006; 118 (01) 95-101
24 Angrigiani C, Grilli D, Karanas YL, Longaker MT, Sharma S. The dorsal scapular island flap: an alternative for head, neck, and chest reconstruction. Plast Reconstr Surg 2003; 111 (01) 67-78
25 Prasad V, Almutairi K, Kimble FW, Stewart F, Morris SF. Dorsolateral musculocutaneous perforators of posterior intercostal artery: an anatomical study. J Plast Reconstr Aesthet Surg 2012; 65 (11) 1518-1524
26 Blondeel PN, Van Landuyt K, Hamdi M, Monstrey SJ. Soft tissue reconstruction with the superior gluteal artery perforator flap. Clin Plast Surg 2003; 30 (03) 371-382
27 Dabernig J, Sorensen K, Shaw-Dunn J, Hart AM. The thin circumflex scapular artery perforator flap. J Plast Reconstr Aesthet Surg 2007; 60 (10) 1082-1096
28 Mun GH, Lee SJ, Jeon BJ. Perforator topography of the thoracodorsal artery perforator flap. Plast Reconstr Surg 2008; 121 (02) 497-504
29 Thomas BP, Geddes CR, Tang M, Williams J, Morris SF. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg 2005; 116 (03) 818-822
30 Hamdi M, Van Landuyt K, Monstrey S, Blondeel P. A clinical experience with perforator flaps in the coverage of extensive defects of the upper extremity. Plast Reconstr Surg 2004; 113 (04) 1175-1183
31 Hwang JH, Lim SY, Pyon JK, Bang SI, Oh KS, Mun GH. Reliable harvesting of a large thoracodorsal artery perforator flap with emphasis on perforator number and spacing. Plast Reconstr Surg 2011; 128 (03) 140e-150e
32 Hamdi M, Spano A, Van Landuyt K, D'Herde K, Blondeel P, Monstrey S. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg 2008; 121 (02) 389-396
33 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
34 Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114 (04) 910-916
35 Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg 2009; 123 (01) 230-235
36 Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg 2010; 64 (03) 291-293
37 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
38 Song S, Jeong HH, Lee Y. , et al. Direction of flap rotation in propeller flaps: does it really matter?. J Reconstr Microsurg 2019; 35 (08) 549-556
39 Datli A, Suh H, Kim YC, Choi DH, Hong JPJ. Free-style deepithelialized propeller flaps: an ideal local flap to obliterate wounds with dead space. Plast Reconstr Surg Glob Open 2017; 5 (03) e1249
40 Arco G, Horch RE, Arkudas A, Dragu A, Bach AD, Kneser U. Double pedicled perforator flap to close flank defects: an alternative for closure of a large lumbar defect after basalioma excision--a case report and review of the literature. Ann Plast Surg 2009; 63 (04) 422-424
41 Sisti A, D'Aniello C, Fortezza L. , et al. Propeller flaps: a literature review. In Vivo 2016; 30 (04) 351-373
42 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
43 ten Wolde B, van den Wildenberg FJ, Keemers-Gels ME, Polat F, Strobbe LJ. Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol 2014; 21 (03) 802-807