Pedicled Propeller Flap Research Articles

Delayed Reconstruction of the Perforator Pedicle Propeller Flap after the Induced Membrane Technique for Gustilo IIIB Open Distal Tibial Fracture.

This study aimed to evaluate the safety and efficacy of delayed reconstruction of the perforator pedicle propeller flap after the induced membrane technique in the treatment of Gustilo IIIB open distal tibial fracture, and to evaluate the clinical outcome and complications of two different perforator pedicle propeller flaps.Thirty-four patients with Gustilo IIIB open distal tibial fractures treated by the induced membrane technique and delayed reconstruction of two different perforator pedicle propeller flaps from May 2017 to March 2022 were retrospectively analyzed. Patients were divided into two groups according to the different kinds of perforator pedicle propeller flaps covered. The operation required two stages. The Radiographic Union Score for Tibial fractures (RUST) was used to evaluate the healing of the tibial bone defect. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate ankle function. The complications associated with the technique were recorded.The number of serial debridements, excluding those performed during emergency and final operations, was a mean of 2.28±0.83 in the PAPF group. The PAPF group had a mean bone defect length of 6.76 ± 0.69 cm, the median healing time of 13.11 ± 0.96 months, RUST score 12.68 ± 1.63, and AOFAS score of 84.12 ± 6.38. On the other hand the PTAPF group's mean bone defect length was 6.73 ± 0.95 cm, the median healing time 12.63 ± 1.46 months, RUST score 13.73 ± 1.53 and AOFAS score 82.79 ± 5.49. There were no observed significant differences the two groups in the number of serial debridements, bone defect length, bone union time, RUST score, or AOFAS score (p>0.05). Flap size ranged from 9×6cm2 to 14×7cm2 in the PAPF group and from 9×6cm2 to 13×7cm2 in the PTAPF group. There were no severe complications such as flap-related complications or amputation. The differences in complications in the two groups were not statistically significant.In cases of severe open tibial fracture, the reconstructive method is important. When delayed reconstruction is inevitable, surgeons should first perform radical debridement, followed by vacuum sealing drainage as a bridging therapy; both PAPF and PTAPF can be considered for definitive soft tissue coverage.

Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects.

To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes. The clinical data of 23 patients (23 eyes) who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed. All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterior- or posterior-layer eyelid defects. The survival rate of the propeller flap, eyelid function and appearance, tumor recurrence rate, and patient satisfaction were evaluated after the surgery. The patients consisted of 12 men and 11 women, aged 31-82y (mean, 58.9y). The longest follow-up time was 5y, and the shortest was 3mo. All the propeller flaps survived well. There was no significant difference in color and luster between the flap and adjacent tissues, and there was no dog ear phenomenon. No obvious scarring was observed. There were no obvious abnormalities of eyelid morphology or function, and no adverse complications such as exposure keratitis, entropion, ectropion, ptosis, and eyelid retraction. No tumor recurrence was found at the time of the last follow-up. All patients were satisfied with the surgical results. The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactory outcomes in terms of eyelid function and esthetics, and merits clinical application.

Turbo-propeller flap for elbow reconstruction under regional anesthesia

Amethod for the reconstruction of an extensive soft tissue defect after acomplicating olecranon fracture is presented. Aperforator-based retrograde pedicled propeller flap was used from the lateral upper arm with additive microvascular "turbo"-anastomosis to the radial artery and vein. The turbo-flap was performed under regional anesthesia.

Parallel Cross-Leg Free Flap with Posterior Tibial Artery Perforator Pedicle Propeller Cable Bridge Flap for the Treatment of Lower Extremity Wounds: A Case Series Report

Background A cross-leg flap can be used to treat severely injured lower limbs but associated with complications. Herein, we describe a technique of a parallel cross-leg free flap combined with posterior tibial artery perforator pedicle propeller cable bridge flap for the treatment of lower extremity wounds. Methods The artery and veins of the free flap are anastomosed to the contralateral posterior tibial artery and vein, respectively. The vascular pedicle is wrapped with a posterior tibial artery perforator pedicle propeller flap. The legs are allowed to remain in a straight, relaxed position which is maintained with a bandage or Kirschner wire placed at the distal limbs. Pedicle division is performed around 21 days after flap creation, and the posterior artery is re-anastomosed and pedicled flap returned to its original position. Results From June 2017 to March 2020, 7 patients with lower extremity wounds and tissue loss received reconstruction with this method. The recipient vessels for all flaps were the posterior tibial artery and vein. The average operation time was 5 hours. The average time to ambulation was 4 weeks, and the average follow-up time was 13.7 months. All flaps survived, and limb salvage was successful in all patients. Patients were not uncomfortable with the limbs held in position until pedicle division, and there were no complications. At the final follow-up, the function of all limbs was normal, and the esthetic appearance was acceptable to all patients. Conclusions The method described overcomes the disadvantages of traditional cross-leg flaps for the treatment.

Subcutaneous pedicled propeller flap for reconstructing the large eyelid defect due to excision of malignancies or trauma

Large eyelid defect after excision of malignancies or trauma is difficult to reconstruct due to special structure and function of the eyelid. In this study, we aimed to present the outcomes of subcutaneous pedicled propeller flap for reconstructing the large eyelid defect after excision of malignancies or trauma. A retrospective review of patients diagnosed with eyelid defect due to excision of malignancies or trauma, and undergoing subcutaneous pedicled propeller flap for reconstructing the large eyelid defect, was conducted at our hospital. The clinical data were collected and analyzed. A total of 15 patients were included in the cases series. Nine patients were diagnosed with basal cell carcinoma, 3 patients with epidermoid carcinoma, and 3 patients with trauma. All the defects were successfully covered with this designed flap. There was no flap necrosis in all the cases. No functional problems were observed in all of the cases. At long-term postoperative follow-up, the average score of patients’ satisfaction was good. This subcutaneous pedicled propeller flap is a feasible alternative technique for reconstructing the large eyelid defect after excision of malignancies or trauma. This flap option could avoid the use of free flaps for large defect.

A Surgical Alternative in the Treatment of Hypopharyngeal Perforation

Summary:Pharyngo-esophageal perforation is a rare, life-threatening complication of anterior cervical discectomy and fusion surgery with an incidence estimated to be between 0.2 and 1.51%. Early diagnosis and appropriate treatment of this complication is the key to reduce morbidity and mortality, as the main prognostic factor is the interval between the onset of the fistula, diagnosis and treatment. Conservative management has shown encouraging results in small and localized defects, whereas surgical approaches using flaps are to be considered for most of the cases. However, there is no clear consensus on the first choice of treatment in esophageal perforation. This case report presents the use of a supra-clavicular fascio-cutaneous pedicled propeller flap as a patch combined to primary repair of a hypopharyngeal perforation, 10 years after anterior cervical spine arthrodesis.

A retrospective study on treatment for postburn contracture of axilla with propeller flap cover at a tertiary care center

Background: The gold standard for burn scar reconstruction is to utilize adjacent skin flaps for the ease of operation and to match the skin characteristics. The objective of this study is to share our experiences using propeller flap cover for “postburn contracture of axilla (PBCA)” release reconstruction. Materials and Methods: This 5-year retrospective observational study was undertaken in the Plastic Surgery Department of GMCH, Guwahati, from 2016 to 2020 with the data available after obtaining the Ethics Committee approval. The patient records and photographs were gathered from the Medical Records and the Plastic Surgery Department of GMCH, Guwahati, respectively. Patients treated with a propeller flap cover were scrutinized. Results: The patients operated for PBCA were 36. There were 12 males and 14 females with a mean age of 21 years. Twelve patients with spared axillary dome skin underwent a central axis subcutaneous pedicle propeller flap. The flaps had dimensions of 8–12 cm in length and 6–9 cm in width. The pedicle was approximately 2–2.5 cm in diameter. The few complications seen included wound dehiscence and delayed wound healing, edge hypertrophy, band contractures, marginal necrosis, and pin cushioning. During follow-up, no recontractures were seen. Conclusions: We conclude that central axis subcutaneous pedicle propeller flap is a simple and effective treatment for mild-to-moderate PBCA with spared axillary dome skin. These flaps provide durable soft tissue cover with enhanced flap survival, functional mobility, and esthetics.

The medial sural artery perforator pedicle propeller flap for lower middle-third anterior tibial soft tissue defect reconstruction: Case report and literature review

Abstract Lower extremity reconstruction still issues a challenge for plastic surgeons. The medial sural artery perforator (MSAP) flap has been reported for use to reconstruct the defects of the knee and proximal-third leg defects in many papers. But there is a few papers that described the technique of using this flap for reaching the middle third led defects. The authors report the first using MSAP propeller flap in Vietnam to cover the defect in a 45-year-old female patient who suffered from chronic ulcer with bone exposure over the middle third anterior tibial and evaluate the result of 4 months post-op. Keywords: Lower extremities defects reconstruction, perforator flap, medial sural artery perforator flap, propeller flap.

Application of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh

To explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh. Between December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade. The distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal. Based on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.

Use of soleus musculocutaneous perforator-based propeller flap for lower extremity wound coverage after osteocutaneous fibula free flap harvest.

Osteocutaneous fibula free flap (OCFFF) donor sites are often covered with skin grafts, with an additional donor site, more postoperative care, and increased cost. The authors examine posterior tibial artery (PTA) based pedicled propeller flaps (PPF) as an alternative for OCFFF donor site coverage. Retrospective review of 16 consecutive patients from 30 to 79 years old, who underwent OCFFF reconstruction of head and neck defects (11 mandibular, 5 maxillary), with the closure of donor site with PPF based on a perforator from PTA. Mean donor site defect measured 12.9 × 5.1 cm, PPF was an elliptical design, and rotated 180 degrees in a propeller fashion, to cover donor site defect. Visual analog scale (VAS) was used to assess esthetic results, functional outcomes assessed using mobility and range of motion (ROM), and secondary complications including infections, hematomas, and seromas were recorded. Follow-up period was noted in months postoperatively. Other information collected included underlying head and neck pathology. Average dimension of PPF measured 13.9 × 4.1 cm. Successful closure of donor site defects in 14 of 16 patients, with two flaps having partial necrosis, one requiring a secondary skin graft. Follow-up was 6 to 10 months, esthetic results with mean VAS 8.8 of 10, full ROM, and mobility noted. No secondary complications were observed. The most common pathology noted was squamous cell carcinoma (6 of 16 patients). PPFs based on the soleus branch of the PTA represent an excellent alternative to skin grafts for the closure of OCFFF donor site defects.

Our Definition of Propeller Flaps and Their Classification.

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.

Smartphone Thermal Imaging Can Enable the Safer Use of Propeller Flaps.

The use of thermography for the identification of cutaneous "hot spots" that coincide with perforators is not a new concept, but the required professional cameras may be prohibitively expensive. Only relatively recently, incredibly cheap but adequate thermal imaging cameras have become available that work in concert with the ubiquitous cell phone. This can now serve as a rapid, accurate, and complementary method for finding a perforator sufficient to serve as the hub for a perforator pedicled propeller flap. In addition, the preferred direction of rotation about that hub, effect of flap insetting on perfusion, and then postoperative monitoring are possible by proper interpretation of corresponding thermograms. Every reconstructive surgeon should be able to obtain this device, and then easily learn what potential attributes for them are available when planning a propeller flap.

The History of Propeller Flaps.

Several pedicled flaps were developed by Hyakusoku at the Nippon Medical School Hospital, Tokyo, Japan, in the 1980s to treat a large number of patients with postburn contractures. In this setting, the propeller flaps were described for the first time in 1991. The term propeller was used because of the blade shape of the skin island rotating on its axis. In 1989, Koshima introduced the term perforator flaps , whereas Hallock, in 2006, applied the perforator flap concept to the propeller flap. The name perforator pedicled propeller flap followed. Propeller flap had developed to be an important operative technique and a hot topic in the field of reconstructive microsurgery, with the important contribution of Teo. In 2009, the First Tokyo Meeting on Perforator and Propeller Flaps was held, where Pignatti reported the consensus on the definition and classification of propeller flaps that was given by the advisory panel of the meeting. Further evolutions developed since then will be described in this dedicated issue of Seminars of Plastic Surgery .

"Namaste Flap": Modification of Subcutaneous Pedicle Propeller Flaps in the Reconstruction of Postburn Axillary and Elbow Contractures.

The reconstruction of the postburn contracture area is always a challenge in the field of plastic surgery. Moreover, the joints are very sensitive to trauma and immobilization, showing a susceptibility to stiffness. The aim of this article is to emphasize the use of "Namaste flap"-modification of subcutaneous pedicle propeller flaps in the reconstruction of postburn axillary and elbow contractures. This is a prospective case study of axillary and elbow contractures managed at a tertiary care hospital using Namaste flap-modification of subcutaneous pedicle propeller flaps from 2010 to 2016. The surgical technique involved raising 2-limbed subcutaneous pedicle-based propellar flap over the contracture using the unburnt skin at the axillary and cubital fossa. The flap with both the limb thus raised was rotated by 90 degrees in the same direction and inserted into the defect. Nine patients including 6 patients with elbow and 3 patients with axillary contractures were included in this study. The mean degree of contracture in axilla and elbow was 78.3 degrees and 59.1 degrees, respectively. The functional results postoperatively were satisfactory. The mean postoperative degree of joint movements in axilla and elbow was 176.3 degrees and 173.6 degrees, respectively. No major complications were encountered. There was a mean period of 12 months of follow-up. In cases where normal skin is still present on the axillary and cubital fossa with scar contracture caused by extensive burns, the subcutaneous propeller flap methods and their modifications should be considered one of the most useful versatile reconstruction methods. Namaste flap in addition to the advantages of subcutaneous pedicle propeller flap also negates the disadvantages caused by the use of split skin grafting of the donor area.

The medial sural artery perforator pedicled propeller flap for coverage of middle-third leg defects

Pedicled medial sural artery perforator (MSAP) flap has been described primarily for the coverage of knee and proximal-third leg defects. The technique for reaching the middle third and its use as a retrograde-flow flap were never demonstrated with clarity. This retrospective case-series aimed to report the author's experience in these regards. Details of all patients who underwent pedicled MSAP flap for lower limb reconstruction over a 7-year period were collected. Surgical outcomes were examined retrospectively. For defects in the anterior middle third of the leg, the "pedicled propeller flap" design was utilized. To determine more distal defects beyond the reach of the anterograde-flow MSAP flap, retrograde-flow pedicled MSAP flaps were used. Eleven anterograde-flow pedicled MSAP flaps were used for defects ranging from the knee to the middle third of the leg. The etiologies of defects included trauma, chronic ulcer, and skin malignancy. All 11 anterograde pedicled MSAP flaps survived and achieved good outcomes. The mean pedicle length was 11.3 cm (range 7-18 cm), and the mean arc length after double pivoting (n = 4) was 29 cm (range 22-36 cm). Of three retrograde-flow pedicled MSAP flaps, two achieved the goal of wound coverage and one suffered complete flap loss. The "pedicled propeller flap" design extends the reach of the anterograde-flow pedicled MSAP flap as far as the middle-third anterior leg defects. Our preliminary experience with retrograde-flow MSAP flap has mixed results. Further studies are required to examine its reliability.

足関節部の軟部組織欠損に対する穿通枝プロペラ皮弁（PPP flap）を使用した軟部組織再建法

足関節部の軟部組織欠損に対する穿通枝プロペラ皮弁（PPP flap）を使用した軟部組織再建法

Perforator pedicled propeller flap: A reliable coverage of wounds around ankle

Background: This study aimed to determine the reliability of perforator pedicled propeller flap for coverage of wounds around the ankle. Materials and Methods: This was a prospective study undertaken between September 2017 and November 2018 in the Division of Plastic and Reconstructive Surgery of our institution. Patients with soft-tissue defect of the ankle referred from the Division of Orthopedic Surgery were included. Those with a scarring in the region of calf in the area of proposed flap were excluded. A detailed history and examination were recorded. A complete blood count, kidney and liver function tests, coagulation profile, and hepatitis B and C and human immunodeficiency viral marker testing were performed following informed consent. Anteroposterior and lateral radiographs of the ankle were taken in all cases. Perforator pedicled propeller flaps were raised in all patients for coverage of soft-tissue defects around the ankle. All patients were followed up regularly. Results: Ten patients with soft-tissue defect around the ankle were referred to our division from the Division of Orthopedic Surgery or admitted through the outpatient department of the Division of Plastic and Reconstructive Surgery of our institution. Eight patients were male and two were female, with the age ranging from 10 to 50 years. The mean operation time was 58 min. Size of the flap varied from 21 cm × 8 cm (168 cm2) to 8 cm × 5 cm (40 cm2). Flaps were rotated through 110°–180°. Out of ten flaps, eight flaps survived completely without any complications. Partial flap loss was found in one patient (10%), marginal flap necrosis in one patient (10%), and none of the flap was lost completely. Thus, the overall success rate of perforator pedicled propeller flap in our study observed was 80%. Conclusion: The perforator-based propeller flap is a versatile and reliable flap for the coverage of soft-tissue defects around the ankle because its vascularity is predictable.

Analysis of the causes and the countermeasures for the serious complications after perforating pedicle flap of lower leg

Objective To analysis causes of the serious complications after the operation of the lower leg perforator pedicle screw flap, and to explore the corresponding countermeasures. Methods From June, 2012 to August, 2016, 60 cases of soft tissue defect of ankle and foot were repaired with propeller flaps pedicled with perforator of lower legs. with the area were soft tissue defect ranged from 3.0 cm×2.0 cm to 19.0 cm×9.0 cm, and all with bone exposure. Two cases of traumatic tissue defect, 7 cases were chronic osteomyelitis of the distal tibia, 13 cases were incision infection and necrosis after the operation of ankle joint fracture and Pilon fracture, 10 cases were simple incision necrosis after calcaneal fracture, 18 cases were calcaneal osteomyelitis, 1 case were soft tissue defect after the ankle tumor operation, 6 cases were soft tissue necrosis after the Achilles tendon rupture, and 3 cases were soft tissue defect of the dorsum with infection. The posterior tibial artery perforator pedicled propeller flap was used in 18 cases. The pedicle of the vascular pedicle was 6.0-18.0 cm from the medial malleolus, the flap rotation was 135°-180°. There were 42 cases of the perforator pedicle propeller flap of the peroneal artery, 5.0-18.0 cm from the pedicle of the vascular pedicle and 120°-180° rotation in the flap. The area of the flap was 9.0 cm×3.0 cm-34.0 cm×18.0 cm. There were 32 cases of direct suture in the donor site and 28 cases of free skin grafting. Results The color, swelling, elasticity, capillary reaction and healing of donor site were observed after operation. There was no flap ischemia occurred in 60 patients. Fourteen cases had venous reflux obstruction, all of which had swelling above II degree, 8 cases had swelling above III degree with obvious purple blood stasis, resulting in partial flap necrosis in 4 cases, all necrosis in 1 case, including 4 cases of free skin grafting, 1 case of flap transplantation and repair. There were 3 cases of necrosis after skin grafting in the flap area, all of which were partial necrosis. There was case of necrosis of the wound surface after direct suture of the donor site and 1 case of skin disintegration after disassembly, and all wounds healed after the replacement of the wound and the external use of the dried blood powder. All the 60 patients were followed-up for 12 to 30 (mean, 24.5)months. The flaps survived and the donor site scars healed well. The range of motion of the ankle was from -10°to 10°(mean, 5.6 °) and the flexion of the plantar was from 20 °to 50 °(mean, 37.8 °). Fourteen patients with venous reflux disorder were followed up for 15 to 28(mean, 22.3)months. The flap and skin graft survived well. Ankle dorsiflexion ranged from -10° to 10 °(mean, 2.4 °) and plantar flexion from 20° to 45 °(mean, 35.6 °). There was no obvious limp in walking. Conclusion Although the overall effect of the lower leg perforator pedicle propeller flap to repair the soft tissue defect of the foot and ankle is satis-factory, there are still various serious complications, which are mainly due to iatrogenic. Doctors should strictly follow the basic principles of skin flap surgery from preoperative to postoperative, and during operation and postoperative man-agement, so as to reduce the incidence of complications. Key words: Lower leg; Perforator vessel; Propeller flap, perforator flap; Ankle and foot; Complication

The Use of Pedicled Perforator Flaps in Chest Reconstruction: A Systematic Review of Outcomes and Reliability.

In recent years, pedicled perforator flaps have revolutionized plastic surgery by reducing donor site morbidity and ensuring larger and deeper reconstructions with local pedicled cutaneous flaps. The aim of the study was to make a systematic review of perforator pedicled propeller flaps (PPPFs) in chest reconstruction. Pubmed and Cochrane databases were searched from 1989 to October 2016 for articles describing the use of PPPFs in chest reconstruction. The preferred reporting items for systematic reviews and meta analyses statement was used in the selection process. The review was registered on international prospective register of systematic reviews. Furthermore, operative technique, indications and complications were searched. Twenty-four articles were selected (174 patients and 182 flaps). Oncological surgery was the first etiology (34.5%), followed by infections (11.5%), chest keloid scars (6.23%), malformations (4.6%), burns (3.4%), chronic ulcers (2.3%), Verneuil disease (1.8%), and acute wounds (1.8%). The arc of rotation was between 90° and 120° in 24.2%. The mean surface of flaps was 127.45 ± 123.11 cm. Dissection was subfascial in 78.5% of the cases. Complications were found in 9.9% of patients and included mainly wound dehiscence (4.4%) and hematoma/seroma (2.2%). One case of total necrosis (0.5%) and 2 cases of partial necrosis (1.1%) were found. The possibility of numerous pedicles makes it possible for PPPFs to offset most areas of wall chest defects. Furthermore, this surgical technique is reliable and reproducible, with lower donor site morbidity than that in the case of muscular flaps, which are classically used in this location.

Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects

Full-thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, whereas cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella. A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017. The propeller flap was planned to rotate around the perforator (as the pivot point), which was detected with a hand-held Doppler in the vicinity of the defect. The flaps were perforator pedicled for 10 patients and subcutaneous pedicled for the other two patients. The flap was rotated around the pedicle and placed on each patient's defect without tension. No vascular compromise occurred with any of the flaps. The most important complications were post-operative oedema and ecchymosis. Inferior eyelid defects including the anterior lamella could be reconstructed by using propeller flaps from the adjacent tissue. The main advantages of this flap included easy access to the defect, no impairment in eyelid function and very good aesthetic results.