Prophylactic Venous Supercharged Radial Collateral Artery Perforator Propeller Flap: Improved Outcome in Perforator Propeller Flaps

Abstract

Propeller flaps provide a safe and reliable reconstructive option. Following flap rotation intraoperatively, a degree of venous stasis occurs. Difficulty lies in predicting whether this is likely to be transient or not. These flaps are therefore frequently at risk of venous congestion which can result in partial or total flap necrosis.1 This results in delayedwound healing and often necessitates further surgical procedures to achieve the final outcome. This defeats the original intention of performing a reliable, one-stage, and aesthetically pleasing reconstructive technique. Subsequent management of flap necrosis can include conservative and surgical management. Long-term dressings and negative pressure therapy, with or without eventual skin grafting, will result in wound healing, but can take time and are incapacitating for patients. The final result, by these means, can potentially negatively impact upper limb function in terms of scar contracture and appear less aesthetically pleasing. We present two prophylactically venous supercharged radial collateral artery perforator (RCAP) propeller flaps in the upper limb and suggest this is a more reliable approach than the standard RCAP flap technique.