Abstract
The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs.
Highlights
The reconstruction of loss of substance due to trauma or oncological excisions has relevant functional and aesthetic implications
According to the definition established during the Consensus Conference of Gent in 2003, perforator flaps are constituted by cutaneous and subcutaneous tissue areas nourished by perforator arterial branches originating from major vascular bundles with an intramuscular or intraseptal course
Eighteen out of twenty-one patients healed with complete flap survival. In this group four patients (19%) showed superficial epidermolysis with spontaneous resolution and secondary healing of the flaps. These flaps were located in the upper limb in one case and in the lower limb in three cases
Summary
The reconstruction of loss of substance due to trauma or oncological excisions has relevant functional and aesthetic implications. According to the definition established during the Consensus Conference of Gent in 2003, perforator flaps are constituted by cutaneous and subcutaneous tissue areas nourished by perforator arterial branches originating from major vascular bundles with an intramuscular or intraseptal course. Taylor et al reported that a single perforator may safely supply its proper angiosome and up to the half of vascular territory of the adjacent perforator [5, 6]. This possibility is favored by vascular adoption directed toward periphery that occurs by means of increased vascular pressure in the perforator artery after ligature of collateral subcutaneous and intramuscular arterial branches. In case of coverage by means of a V-Y type advancement, local perforator flaps can reach considerable displacements covering distances greater than those obtained by the use of standard V-Y flaps
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