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Angelini A, Tiengo C, Cerchiaro MC, Soto F, Biz C, Messana F, Bassetto F, Ruggieri P. Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections. Microsurgery 2024; 44:e31168. [PMID: 38549392 DOI: 10.1002/micr.31168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 01/20/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. METHODS We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. RESULTS The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. CONCLUSIONS The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Cesare Tiengo
- Department of Plastic surgery, University of Padua, Padova, Italy
| | | | - Fernando Soto
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Carlo Biz
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | | | - Franco Bassetto
- Department of Plastic surgery, University of Padua, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
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2
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Khayat S, Bonsfills N, Antúnez-Conde R, Álvarez-Mokthari S, Aranibar H, Tousidonis M, Fernández-Fernández M, Díez-Montiel A. Parascapular Flap for Severe Hidradenitis Suppurativa. Case Rep Dermatol 2024; 16:8-16. [PMID: 38188892 PMCID: PMC10769502 DOI: 10.1159/000533387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/27/2023] [Indexed: 01/09/2024] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disease which affects apocrine glands and hair follicles of the skin, primarily in the axillary and groin regions. This condition can be highly debilitating, causing painful lesions and a negative psychological impact on patients. While medical and minimally invasive treatments are available, surgical intervention may be necessary for severe cases. In cases involving axillary defects, the use of local flaps such as the parascapular flap is a viable option. In this case report, we present a 34-year-old woman who presented to our clinic with a history of recurrent abscesses and cutaneous infections in the axillary region. After thorough evaluation, we chose to use the parascapular flap for reconstruction. The parascapular flap is a one-stage procedure that allows for extensive resection of the axillary area without resulting in contractions or retractions over the long term. Additionally, this technique allows for preservation of the axilla's original shape with minimal donor site morbidity.
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Affiliation(s)
- Saad Khayat
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Nuria Bonsfills
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | | | - Sara Álvarez-Mokthari
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Hubert Aranibar
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Tousidonis
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Mario Fernández-Fernández
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
- Department of Otorhinolaryngology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Díez-Montiel
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
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Han T, Khavanin N, Zhu S, Zang M, Li S, Chen Z, Liu Y. Utilization of two methods assisting perforator identification for brachial artery perforator propeller flap application. J Plast Reconstr Aesthet Surg 2023; 87:371-378. [PMID: 37931513 DOI: 10.1016/j.bjps.2023.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
The brachial artery perforator propeller (BAPP) flap has the advantages of both local and perforator propeller flaps, and it remains relatively underused partly because of the anatomical variations of perforators in the medial arm. We aimed to review our preliminary experience using two different methods for perforator localization of a BAPP flap, including the application of a refined coordinate system (the ABC system) in the medial arm and indocyanine green angiography (ICGA). We evaluated the advantages and disadvantages of these methods and selected the optimal examination mode depending on detailed clinical settings. The perforator was identified for each patient using the ABC system and/or ICGA, depending on the clinical setting. Twenty-two patients underwent soft-tissue reconstructions with 22 BAPP flaps, and perforator localization for all the flaps was performed before surgery using the ABC system. Thirty-one perforators were localized before surgery and marked accordingly, all of which were visualized during surgery, except two, which were not found during the surgery. ICGA was used in six pre-expanded flaps at both stages of surgeries. Twenty-seven perforators were detected before surgery, and all of them were identified during surgery; the previously localized perforators found using the ABC system in the six patients were all reidentified using ICGA. Both the ABC system and ICGA were found to be useful for preoperative perforator localization in BAPP flap transfers. Each method has its unique downsides; however, they can supplement each other to facilitate safe and effective flap elevation. Therefore, selection of the optimal method based on the clinical settings is recommended.
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Affiliation(s)
- Tinglu Han
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Nima Khavanin
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shan Zhu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Mengqing Zang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shanshan Li
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zixiang Chen
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanbo Liu
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Benedetti F, Kafury P, Reyes-Arceo F, Lizardo C, Reina F, Zuluaga M. Use of Propeller Flaps for the Reconstruction of Defects around the Ankle. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2023. [DOI: 10.1055/s-0043-1762894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Abstract
Background This article describes the clinical results of the use of propeller flaps during reconstruction of coverage defects around the ankle.
Methods A retrospective study of all patients with bone and soft tissue defects around the ankle reconstruction using propeller flap between January 2021 and December 2022 was conducted. Flap survival rate and complications were the outcomes variables.
Results A total of 14 reconstructions in 13 patients (mean age: 45.8 ± 16.7 years) using propeller flaps were performed in the study period. The medial malleolus was the most affected area (n = 5) and the defect size ranged from 12 to 33.7 cm2. The posterior tibial artery was used as a perforator in 11 flaps. Complications were identified in five flaps, four developed venous congestion and one case, reactivation of infection. Only one propeller flap presented complete failure associated with necrosis. Good soft tissue coverage was achieved in 13 of 14 flaps.
Conclusion Propeller flaps proved to be a valid management option during reconstruction of bone and soft tissue defects around the ankle, offering adequate coverage in most cases. Adequate patient selection is important to decrease the risk of complications.
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Affiliation(s)
- Fernando Benedetti
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
- Faculty of Health Sciences, Pontificia Universidad Javeriana Cali, Colombia
| | - Paola Kafury
- Department of Plastic and Reconstructive Surgery, Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
| | - Fabiola Reyes-Arceo
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
| | - Carmelo Lizardo
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
| | - Federico Reina
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
| | - Mauricio Zuluaga
- Limb Lengthening and Reconstruction Unit, Clínica Imbanaco Grupo Quirón salud, Cali, Colombia
- Faculty of Health Sciences, Pontificia Universidad Javeriana Cali, Colombia
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Abstract
A propeller flap is an islanded flap that reaches the recipient site through an axial rotation around its vascular axis. The degree of rotation varies from 90 degrees to 180 degrees. It is a highly reliable local reconstructive option. These flaps are simple, single-stage, easy to harvest, and not constrained by routine length-to-width ratios. Since their introduction, the technique has continued to evolve and more applications for the use of propeller flaps are being explored. In spite of their growing use in clinical practice in recent years, many reconstructive surgeons are unaware of their versatility, unsure of their safety, and apprehensive about using propeller flaps confidently. This article aims at understanding the nomenclature, key principles, biogeometry and planning, operative technical details, applications, and complications of propeller flaps.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic & Reconstructive Surgery, B. J. Government Medical, College and Sassoon Hospital, Pune, Maharashtra, India,Address for correspondence Nikhil Panse, MCh, DNB Department of Plastic and Reconstructive Surgery, B.J.G.M.C. and Sassoon General HospitalPune, Maharashtra 411001India
| | - Ankur Karanjkar
- Department of Plastic & Reconstructive Surgery, B. J. Government Medical, College and Sassoon Hospital, Pune, Maharashtra, India
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Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3993. [PMID: 34934603 PMCID: PMC8683242 DOI: 10.1097/gox.0000000000003993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Abstract
Background: In distal lower limb defects, the paucity of local tissues dictates a free-flap (FF)-based reconstruction frequently. The propeller perforator flap (PPF) offers a good alternative when the patient or the limb or both are not fit for FF-based reconstruction. Also, in contexts of restricted healthcare resources, armed conflict scenarios, or during pandemics like the ongoing COVID-19 pandemic, PPF is considered a valuable alternative to free-flap-based reconstruction. Additionally, PPFs are less sacrificing in terms of major limb vessels and distal limb vascularity. Yet, the distal lower limb vascular impact for PPF-based reconstruction has not been studied before. Methods: In total, 23 patients with distal lower limb defects were reconstructed with PPFs. By using U/S arterial duplex, the peak arterial velocity (PA velocity) was measured pre and postoperatively in 15 (65.2%) out of the 23 patients. This measurement was done to the vessel segment distal to the used perforator. Results: An estimated 21 out of 23 flaps succeeded to reconstruct the patients’ defects safely and to give all patients stable coverage without further surgeries. Only two patients had flap failure, which was managed successfully through additional reconstruction sessions. The difference between pre- and postoperative PA velocity was not statistically significant. Conclusions: PPFs are a safe cost-effective reconstruction modality for distal lower limb defects. This advantage is very valuable in cases of restricted healthcare resources, wars, and during pandemics. In terms of distal limb vascularity, PPFs have no significant impact and can be used safely.
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Yadav P, Thakur S, Agarwal P, Sharma D, Kukrele R. Perforator-based propeller flap for coverage of lower leg: Single centre experience. Trop Doct 2021; 51:331-338. [PMID: 33472566 DOI: 10.1177/0049475520988225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was conducted to assess outcomes of propeller flaps for reconstruction of small- to medium-sized defects in the distal third of the leg. Of 53 lower third leg defects covered using the propeller flap, 43 survived without complications. Only minor complications were seen and no flap was lost completely. The propeller flap is thus a safe option for medium-sized defects of the lower leg.
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Affiliation(s)
- Prashant Yadav
- Doctor, Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Sharad Thakur
- Doctor, Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Pawan Agarwal
- Professor, Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhananjaya Sharma
- Professor, Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Rajeev Kukrele
- Doctor, Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, India
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8
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Soft Tissue Reconstructions After Sarcoma Resection. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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9
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Sequential propeller flaps in the treatment of post-traumatic soft tissue defects of the lower limb - a case series. Injury 2020; 51:2922-2929. [PMID: 32089279 DOI: 10.1016/j.injury.2020.02.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Propeller flaps have gained great popularity among reconstructive surgeons; however, the inability to directly close the donor site of large propeller flaps constitutes a well-known limitation of this technique. Skin grafting of the donor area is not always feasible nor desirable. To address large propeller flaps secondary defects, we investigated the use of a second propeller flap harvested from a nearby region of relative skin redundancy to assist the donor site closure generated by the first. Since the donor defect of the second flap is closed by direct suture, the aim of this "sequential" propeller flaps technique is to achieve complete, like-with-like, soft tissue restoration while avoiding skin grafting. METHODS From April 2018 to September 2019, eight patients presenting post-traumatic soft tissue defects were planned to be reconstructed by means of the sequential propeller flaps technique, for a total of 16 propeller flaps. The locations of the defects included the distal leg in four cases, the heel in two cases, the proximal lateral thigh in one case and proximal posterior thigh in the remaining one. All the flaps but one were harvested as a perforator-based propeller type and rotated by different degrees around the skeletonized perforator. In one patient, due to an intraoperative complication following the first flap harvest, the harvest of the second flap was abandoned. RESULTS In all but one patient, a complete, tension free primary closure of all wounds was achieved without complications, the functional recovery as well the esthetic outcome were excellent. One patient showed intraoperative signs of vascular insufficiency involving 15% of the first flap. The plan of harvesting the second flap was intraoperatively abandoned and the definitive wound closure with a free muscle gracilis was carried out the following week. CONCLUSION In some selected cases, the use of multiple propeller flaps performed in sequence allows the surgeon to obtain complete, like-with-like wound closure with vascularized tissue avoiding a free tissue transfer procedure, however, it requires a vast experience with propeller flaps and meticulous preoperative planning.
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10
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Cordova A, D'Arpa S, Rosatti F, Nichelini M, D'Antonio GM, Giordano S, Toia F. Propeller Flaps in the Head and Neck. Semin Plast Surg 2020; 34:165-170. [PMID: 33041686 DOI: 10.1055/s-0040-1714269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Propeller flaps have significantly expanded the reconstruction possibilities in the head and neck region. They allow for increased flap mobility and better scar concealing, and/or to perform a one-stage reconstruction with local tissue of similar color and texture, where multiple surgeries would be needed with traditional flaps or even free flaps would be required. This article describes the main propeller flaps for one-stage reconstruction in the head-neck region (facial artery perforator, supratrochlear artery axial perforator, deep lingual artery axial perforator, and anterior supraclavicular artery perforator flaps), their indications, and possible complications. Aesthetic and functional results of propeller flaps in the head and neck region are very good and the complication rate is low, but due to their surgical complexity and the availability of many simpler local flaps, they are indicated only in select cases where local flaps are unavailable or would require multiple staged procedures to complete the construction.
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Affiliation(s)
- Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Fernando Rosatti
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marta Nichelini
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giovanni Maria D'Antonio
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Giordano
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesca Toia
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Abstract
Wounds of the lower extremity involving the distal third of the leg remain a significant challenge due to anatomic location and often poor host physiology. Perforator-based propeller flaps may provide rapid coverage of these wounds with a relatively low rate of major complications and often readily managed minor complications. A thorough vascular evaluation must be performed prior to the procedure to ensure adequate flap design and selection of the correct perforator is performed. They have the added advantage over their soft tissue free flap counterparts in that they have significantly less host morbidity with similar rates of total necrosis.
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12
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Valente ADS, de Borba DF, de Resende DR, Resende MR, Goulart RG, Lima SJD. Use of Propeller Flap in the Coverage of Soft-Tissue Injury in the Lower Limb. Rev Bras Ortop 2020; 56:192-197. [PMID: 33935314 PMCID: PMC8075643 DOI: 10.1055/s-0040-1714223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
Objective
To evaluate the use of a propeller flap to cover soft-tissue injuries in the lower limb.
Materials and Methods
A retrospective study, with review of medical records, and a convenience sample of 14 patients operated between July 2018 and June 2019. The following clinical aspects were evaluated: sex; age group; type of injury; cause of the injury; initial diagnosis; affected location; techniques for incision and identification; surgical planning; flap design; postoperative period; result of the propeller flap; and complications.
Results
The sample was composed of male patients (100%), with a mean age of 36.4 years, and 92.7% of the injuries resulted from motorcycle accidents, mostly on the right side (71.4%). The surgical planning of the propeller flap followed the same procedure in all cases. Immediate postsurgical complications were present in 35.7% of the cases, and they included excessive bleeding (14.3%), partial necrosis (14.3%), and flap dehiscence (7.1%). In total, 13 patients had excellent coverage, and only 1 had flap loss.
Conclusion
The propeller-flap technique to cover lesions in the lower limb proved to be a good alternative in most cases evaluated, with a good surgical result, although complications were observed in some cases.
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Affiliation(s)
- Adison de Souza Valente
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Denis Ferreira de Borba
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Daniel Ribeiro de Resende
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Meyrelles Rodrigues Resende
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Ricardo Gouvea Goulart
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
| | - Sérgio José de Lima
- Departamento de Ortopedia e Traumatologia, Hospital de Urgências de Goiânia Dr. Valdemiro Cruz, Goiânia, GO, Brasil
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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.
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Affiliation(s)
- Daniel J Kedar
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Changsik John Pak
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunsuk Peter Suh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Cha HG, Kang MK, Kim W, Lee JS, Hong JP, Suh HP. Oncologic safety of propeller flap and free flap in reconstruction after soft tissue sarcoma resection. J Surg Oncol 2020; 122:787-794. [PMID: 32596810 DOI: 10.1002/jso.26076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/20/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES The propeller flap is a reliable option for reconstruction after soft tissue sarcoma resection. However, some parts of the resection margin may move away from its original position during flap rotation and thus can be excluded from the clinical target volume of adjuvant radiotherapy. This study aimed to evaluate local recurrence after soft tissue sarcoma resection with propeller flap or free flap reconstruction. METHODS Patients who underwent resection of soft tissue sarcoma followed by a free flap or propeller flap reconstruction and adjuvant radiotherapy at a single institution were retrospectively reviewed. RESULTS The 1- and 3-year local control rates were 94.6% and 88.6% in the free flap group vs 90.6% and 87.5% in the propeller flap group, without statistical significance. There were no statistically significant differences in 5-year local recurrence-free survival (88.6% vs 87.5%) and disease-free survival (82.5% vs 74.8%) between the groups. CONCLUSIONS Although there was no significant difference in local control and disease-free survival rates between propeller flap and free flap reconstruction after soft tissue sarcoma resection, a multidisciplinary approach is needed to obtain surgical information for determining the accurate clinical target volume of adjuvant radiotherapy and the area for meticulous follow-up postoperatively.
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Affiliation(s)
- Han Gyu Cha
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Korea
| | - Min Kyu Kang
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunsuk Peter Suh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Pignatti M, Ogawa R, Mateev M, Georgescu AV, Balakrishnan G, Ono S, Cubison T, Pinto V, D'Arpa S, Koshima I, Hyakusoku H, Hallock GG. Our Definition of Propeller Flaps and Their Classification. Semin Plast Surg 2020; 34:139-144. [PMID: 33041682 PMCID: PMC7542214 DOI: 10.1055/s-0040-1715158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90 degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isolated perforator, and the terms propeller and perforator flap were used together. Thereafter, the surgical technique of propeller flaps evolved and new applications developed. With the "Tokyo consensus," we proposed a definition and a classification schema for propeller flaps. A propeller flap was defined as an "island flap that reaches the recipient site through an axial rotation." The classification included the SPP (SPP) flap, the perforator pedicled propeller (PPP) flap, and the supercharged PPP (SCP) flap. A recent update added a new category, the axial pedicled propeller (APP) flap. Here we propose our updated and comprehensive classification of propeller flaps, taking into account the previous classification and subsequent publications. Based on their vascular pedicle, we consider the following five types of propellers: (1) SPP flap, 2.PPP flap, its subtype (2a) SCP flap, (3) APP flap, (4) muscle propeller flap, and (5) chimeric propeller flap. The variables that can be taken into account in the classification are as follows: type of nourishing pedicle, degrees of skin island rotation, position of the nourishing pedicle, artery of origin of the pedicle, and flap shape.
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Affiliation(s)
- Marco Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Bologna, Italy
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Musa Mateev
- Department of Plastic Surgery, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Alexandru V. Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, Clinical Hospital of Rehabilitation, University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Govindasamy Balakrishnan
- Plastic, Hand & Microvascular Surgery, Right Hospitals, Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
| | - Shimpei Ono
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Tania Cubison
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Valentina Pinto
- Department of Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Bologna, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences (DICHIORONS), University of Palermo, Palermo, Italy
| | - Isao Koshima
- International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiko Hyakusoku
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Geoffrey G. Hallock
- Division of Plastic Surgery, Sacred Heart Campus, St. Luke's Hospital, Allentown, Pennsylvania
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Ellabban MA, Awad AI, Hallock GG. Perforator-Pedicled Propeller Flaps for Lower Extremity Reconstruction. Semin Plast Surg 2020; 34:200-206. [PMID: 33041691 PMCID: PMC7542202 DOI: 10.1055/s-0040-1715154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reconstruction of the lower extremity is considered a major challenge due to frequent bone exposure and the absence of local tissue redundancy, as well as often due to the presence of vascular insufficiency. Many surgeons have preferred free flaps especially for reconstructing the more distal lower limb defects until the evolution of pedicled perforator flaps and propeller flaps in particular provided a like-with-like reconstruction of the lower extremity without affecting the main vessels of the limb or the underlying muscles, and without the risk of any microanastomosis especially in patients with multiple comorbidities. Perforator-pedicled propeller flaps as local flaps in the lower extremity are best suited for small- and medium-sized defects with minimal donor-site morbidity, regardless of the cause of the defect. Any of the three source vessels of the leg can provide reliable perforators for propeller flap coverage of the distal leg and foot. The three main risk factors that are relative contraindications may be advanced age, diabetes mellitus, and atherosclerotic peripheral vascular disease.
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Affiliation(s)
- Mohamed A. Ellabban
- Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Ahmed I. Awad
- Plastic and Reconstructive Surgery Unit, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Geoffrey G. Hallock
- Division of Plastic Surgery, St. Luke's Hospital – Sacred Heart Campus, Allentown, Pennsylvania
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17
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Cajozzo M, Jiga LP, Jandali Z, Muradov M, Pignatti M, Cordova A, D'Arpa S. Complications and Solutions in Propeller Flap Surgery. Semin Plast Surg 2020; 34:210-220. [PMID: 33041693 PMCID: PMC7542210 DOI: 10.1055/s-0040-1714087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Propeller perforator flaps (PPFs) have long been proven as valid reconstructive tools for a wide range of soft tissue defects in different body regions. During the last decade, despite their numerous advantages, many authors have thoroughly analyzed outcomes of these flaps, sometimes discouraging their use mainly because of a high failure rate. Accurate patient selection, adequate preoperative planning, and an appropriate dissection technique seem to potentially improve outcomes. Our study provides a review of the relevant literature related to PPF complications and of our experience, describing reasons for failure, measures for preventing them, and approaches for a prompt evaluation and management of complications.
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Affiliation(s)
- Marta Cajozzo
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Lucian P. Jiga
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Zaher Jandali
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Mismil Muradov
- Department of Plastic Surgery, Syzganov National Scientific Center of Surgery, Almaty, Kazakhstan
| | - Marco Pignatti
- Department of Plastic Surgery, Policlinico di Sant'Orsola, DIMES, Bologna University, Bologna, Italy
| | - Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Salvatore D'Arpa
- Division of Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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Innocenti M, Dell'Acqua I, Famiglietti M, Vignini L, Menichini G, Ghezzi S. Free perforator flaps vs propeller flaps in lower limb reconstruction: A cost/effectiveness analysis on a series of 179 cases. Injury 2019; 50 Suppl 5:S11-S16. [PMID: 31706586 DOI: 10.1016/j.injury.2019.10.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this report is to compare free perforator flaps and propeller flaps in the coverage of lower limb soft tissue defects. PATIENTS AND METHODS 179 patients (age between 5 and 92 years old), underwent soft tissue reconstruction of the lower limb between January 2009 and January 2015, either by free flap or propeller flap. The two groups were retrospectively evaluated in order to assess the outcome, complications and potential risk factors. Correlations between risk factors and presence/absence of failure or complications have been evaluated with descriptive statistical analysis and a set of logistic regression models. Finally, an economic analysis was conducted to evaluate the different tecniques. RESULTS In a simple descriptive statistical analysis, the overall failure rate is 6% for free flaps and 3.7% for propeller flaps; the complication rates are 14% vs 21.5% and it increases as dimension increases. The logistic models relating failure and complications with potential risk factors do not show significant differences, whereas the economic analysis show that the average expense of free flaps is 5077.5€ per patient, 1595.6€ per patient for propeller flaps. CONCLUSIONS Our results do not demonstrate significant differences between the two groups about correlation of risk factors or flap size with complication or failure. The surgical option choice should be taken only after accurate evaluation of the soft tissue surrounding the defect. Propeller flaps should be preferred in case of small/medium size defects in otherwise healthy extremities. Free perforator flaps should be the choice in large defects due to trauma or vascular diseases. The economic analysis suggests that propeller flap should be considered when possible.
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Affiliation(s)
- Marco Innocenti
- Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy.
| | - Irene Dell'Acqua
- Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy
| | - Matteo Famiglietti
- Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy
| | - Livia Vignini
- Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy
| | - Giulio Menichini
- Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy
| | - Serena Ghezzi
- Department of Plastic and Reconstructive Surgery and Microsurgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy.
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Lonie S, Grinsell D, Mah E. Propeller flap reconstruction of irradiated sarcoma defects: A comparison✰. J Plast Reconstr Aesthet Surg 2019; 72:181-187. [DOI: 10.1016/j.bjps.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/16/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022]
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20
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Tsapralis N, Pham H, Vlachogiorgos A, Kosutic D. "Blood letting" technique with externalized microvascular anastomotic coupler: A salvage option to release intraoperative venous congestion of propeller flap. Microsurgery 2018; 39:276-277. [PMID: 30566749 DOI: 10.1002/micr.30412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/09/2018] [Accepted: 11/27/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Nikolaos Tsapralis
- Department of Plastic Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hien Pham
- Department of Plastic Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Apostolos Vlachogiorgos
- Department of Plastic Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Damir Kosutic
- Department of Plastic Surgery, The Christie NHS Foundation Trust, Manchester, United Kingdom
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D’arpa S, Cillino M, Mazzucco W, Rossi M, Mazzola S, Moschella F, Cordova A. An algorithm to improve outcomes of radial forearm flap donor site. Acta Chir Belg 2018; 118:219-226. [PMID: 29202648 DOI: 10.1080/00015458.2017.1411555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstarct Background: Due to the high rate of donor site complications the Radial Forearm Flap (RFF) has lost ground in favor of the Antero-lateral tight flap (ALT) and other flaps. We have designed a reconstruction algorithm for reconstruction of its donor site. The goal of this study was to retrospectively evaluate the impact of this algorithm on RFF donor site complication rates. METHODS The authors analyzed retrospectively 31 patients who underwent free radial forearm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was harvested suprafascial with those in which the flap was harvested as subfascial. RESULTS Before application of the algorithm, there was a 23.3% complication rate at the RFF donor site, in our experience. After introduction of the algorithm, complication rate has dropped to 3.2%, consisting in a partial skin graft necrosis treated by local wound-care and healed without further intervention. CONCLUSIONS Application of the algorithm described has led to a significant reduction in RFF donor site complication rates. This demonstrates that if flap donor sites are analyzed and tailor treated in the same way as primary defects are, instead of being given secondary importance and just grafted, outcomes improve.
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Affiliation(s)
- Salvatore D’arpa
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
- Deparment of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michele Cillino
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Cancer Registry of Palermo and Province Department for Health Promotion Science and Mother and Child, “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Sergio Mazzola
- Cancer Registry of Palermo and Province Clinical Epidemiology and Cancer Registry Operative Unit, University Hospital Policlinico “Paolo Giaccone”, Palermo, Italy
| | - Francesco Moschella
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Abstract
PURPOSE Propeller flaps are island flaps that reach the recipient site through an axial rotation. The flap has a subcutaneous pedicle on which it pivots, thereby resembling a helicopter propeller. We present our series of propeller flaps for the reconstruction of large eyelid defects. METHODS This is a retrospective review of the clinical case notes of eight patients that underwent tumour excision with reconstruction with a cutaneous propeller flap supplied by a non-perforator orbicularis pedicle between July and December 2016. RESULTS Propeller flaps were used in the reconstruction of five lower lid defects (size range 19 × 5 mm to 25 × 8 mm), one medial canthus defect (13 mm diameter), one complete upper lid defect (42 × 19 mm diameter) and one lid sparing extenteration defect. The flaps were recruited from nasolabial, lateral canthal, temple or medial upper cheek skin. Post-operatively one case had 'trapdooring' which required flap revision at 4 months and one had persistent oedema that settled without intervention. CONCLUSIONS The reconstruction of large eyelid defects is challenging in part because of the paucity of locally available skin. Propeller flaps are a paradigm shift in periocular reconstruction in which the subcutaneous pedicle enables the recruitment of large and highly mobile skin flaps from a wide area of regional tissue.
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Affiliation(s)
- Saul N Rajak
- The Sussex Eye Hospital, Brighton and Sussex University Hospital, Brighton, UK. .,South Australian Institute of Ophthalmology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
| | - Shyamala C Huilgol
- Department of Dermatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Masahiro Murakami
- Department of Plastic and Reconstructive Surgery, Nippon Medical School Musashi-Kosugi Hospital, Tokyo, Japan
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
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23
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Toia F, D'Arpa S, Pignatti M, Noel W, Cordova A. Axial propeller flaps: A proposal for update of the "Tokyo consensus on propeller flaps". J Plast Reconstr Aesthet Surg 2017; 70:857-860. [PMID: 28285010 DOI: 10.1016/j.bjps.2017.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, Via del Vespro, 129, Palermo, Italy
| | - Salvatore D'Arpa
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Department of Plastic and Reconstructive Surgery, Gent University Hospital, De Pintelaan 185, Gent, Belgium.
| | - Marco Pignatti
- Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy
| | - Warren Noel
- Department of Plastic and Reconstructive Surgery, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, Paris, France
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, Via del Vespro, 129, Palermo, Italy
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Perforator Propeller Flap for Oncologic Reconstruction of Soft Tissue Defects in Trunk and Extremities. Ann Plast Surg 2016; 77:456-63. [DOI: 10.1097/sap.0000000000000649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Central artery perforator propeller flap for nasal and medial canthal defects. J Plast Reconstr Aesthet Surg 2016; 69:e180-5. [DOI: 10.1016/j.bjps.2016.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/28/2016] [Accepted: 04/24/2016] [Indexed: 11/23/2022]
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Ardelean F, Muntean M, Dumitrascu D, Strilciuc S, Georgescu AV. Perforator flaps in hand reconstruction: the effect of blood vessel twisting. Med Pharm Rep 2015; 88:343-7. [PMID: 26609268 PMCID: PMC4632894 DOI: 10.15386/cjmed-448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Perforator flaps increasingly find acceptance and use in hand reconstructive surgery. A propeller flap is an island flap that moves from one orientation to another by rotating around its vascular pedicle. It is now possible to design propeller flaps based on a single perforator, so-called "perforator-based propeller flaps," but they are more prone to vascular impairment when twisted more than 90°. METHODS We present a prospective study conducted in the Plastic and Reconstructive Surgery Department of the Rehabilitation Hospital over 17 months. All perforator-based propeller flaps that were used for hand reconstruction were analyzed. The parameters studied included the size and location of the defect, the size and shape of the flap, the perforator (length and location) that was used, the degree of twisting of the perforator, the degree of perforator dissection, the management of the donor site, and flap survival area. RESULTS In this study we investigated the circulatory impairment induced by twisting of the pedicle on a true perforator flap. All flaps survived completely with the exception of partial skin necrosis in few cases. Some of these cases required debridement and skin grafting. CONCLUSIONS Perforator-based propeller flaps provide a reliable option for covering small- to medium-size hand complex tissue defects. They have the advantages of using similar tissues in reconstruction, not damaging another area, they do not require main vessels sacrifice, and the donor site can be generally directly closed.
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Affiliation(s)
- Filip Ardelean
- Department of Plastic and Reconstructive Microsurgery, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maximilian Muntean
- Department of Plastic and Reconstructive Microsurgery, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dinu Dumitrascu
- Department of Anatomy, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stefan Strilciuc
- Department of Health Policy and Public Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Alexandru Valentin Georgescu
- Department of Plastic and Reconstructive Microsurgery, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Exposed subcutaneous implantable devices: an operative protocol for management and salvage. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e343. [PMID: 26034650 PMCID: PMC4448718 DOI: 10.1097/gox.0000000000000303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Implantable venous and electrical devices are prone to exposure and infection. Indications for management are controversial, but—especially if infected—exposed devices are often removed and an additional operation is needed to replace the device, causing a delay in chemotherapy and prolonging healing time. We present our protocol for device salvage, on which limited literature is available. Methods: Between 2007 and 2013, 17 patients were treated (12 venous access ports, 3 cardiac pacemakers, and 2 subcutaneous neural stimulators). Most patients were operated within 7 days from exposure. All patients received only a single perioperative dose of prophylactic antibiotic. In cases of gross infection (n = 1), the device was immediately replaced. In the absence of clinical signs of infection: Results: Sixteen devices were saved. Only one grossly infected pacemaker was removed and replaced immediately. Only in 1 case, exposure of a venous port recurred after 18 months and was successfully moved to a subpectoral pocket. Chemotherapy was always restarted as scheduled and electrical devices remained functional. Conclusions: This protocol allows—with a straightforward operation and simple measures—to save exposed devices even several days after exposure. Submuscular placement or immediate replacement is indicated only in selected cases.
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Kang JS, Choi HJ, Tak MS. Reconstruction of Heel With Propeller Flap in Postfasciotomy and Popliteal Artery Revascularization State. INT J LOW EXTR WOUND 2015; 15:132-5. [PMID: 25673623 DOI: 10.1177/1534734614568376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Free flaps are still the gold standard for large defects of the lower limb, but propeller perforator flaps have become a simpler and faster alternative to free flaps because of some advantages such as reliable vascular pedicle, wide mobilization and rotation, great freedom in design, low donor site morbidity, and easy harvest with no requirement for anastomosis. But when the vessels show insufficient findings in preoperative evaluation using a Doppler probe or the vessel is injured, the surgeon should avoid performing free flap surgery to prevent flap failure and should select a propeller perforator flap as an alternative method on the condition that more than one perforator is intact. In this study, we report reconstruction of soft tissue defects of the heel with a pedicled propeller flap in postfasciotomy and popliteal artery revascularization state by making an incision on the central portion above the Achilles tendon, which can be covered by the posterior tibial artery perforator or the peroneal artery perforator based flaps. In conclusion, we showed that although the popliteal artery was injured, the soft tissue defect can be reconstructed using a perforator propeller flap if intact distal flow in the anastomosis site was confirmed.
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Affiliation(s)
- Jin Seok Kang
- Department of Plastic & Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hwan Jun Choi
- Department of Plastic & Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Min Sung Tak
- Department of Plastic & Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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