Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

  • Lazzeri, Davide (Plastic and Reconstructive Surgery Unit, Hospital of Pisa) ;
  • Huemer, Georg M. (Section of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Linz) ;
  • Nicoli, Fabio (Department of Plastic and Reconstructive Surgery, University of Tor Vergata) ;
  • Larcher, Lorenz (Section of Plastic, Aesthetic and Reconstructive Surgery, General Hospital Linz) ;
  • Dashti, Talal (Al-Babtain Hospital for Burn and Plastic Surgery) ;
  • Grassetti, Luca (Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital) ;
  • Li, Qingfeng (Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine) ;
  • Zhang, Yixin (Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine) ;
  • Spinelli, Giuseppe (Maxillofacial Surgery Unit, Hospital of Florence) ;
  • Agostini, Tommaso (Maxillofacial Surgery Unit, Hospital of Florence)
  • Received : 2012.08.06
  • Accepted : 2012.12.18
  • Published : 2013.01.15
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Abstract

Background The aim of this investigation was to systematically review the current literature to provide the best data for indications, outcomes, survival, and complication rates of pedicled propeller perforator flaps for upper body defects. Methods A comprehensive literature review for articles published from January 1991 to December 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articles without available full-text, single case reports or papers with excessive missing data were excluded. Papers reporting pedicle-perforator (propeller) flaps used for lower extremity reconstruction were excluded from meta-analysis. Results From the initial 1,736 studies our search yielded, 343 studies qualified for the second stage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusion and exclusion criteria. Of the selected 41 articles, 26 were case series, original papers or retrospective reviews and were included, whereas 15 were case report papers and therefore were excluded. Two hundred ninety-five propeller flaps were reported to have been used in a total of 283 patients. Indications include repair of trauma-induced injuries, post-trauma revision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with a major complication rate (3.3%) comparable to that of free flaps. No specific exclusion criteria for the procedure were presented in the studies reviewed. Conclusions Pedicled propeller flaps are a versatile and safe reconstructive option that are easy and quick to raise and that provide unlimited clinical solutions because of the theoretical possibility of harvesting them based on any perforator chosen among those classified in the body.

Keywords

References

  1. Karsidag S, Ozcan A, Sumer O, et al. Single-stage ala nasi reconstruction: lateral nasal artery perforator flap. J Craniofac Surg 2010;21:1887-9. https://doi.org/10.1097/SCS.0b013e3181f4af27
  2. Lecours C, Saint-Cyr M, Wong C, et al. Freestyle pedicle perforator flaps: clinical results and vascular anatomy. Plast Reconstr Surg 2010;126:1589-603. https://doi.org/10.1097/PRS.0b013e3181f02ee3
  3. D'Arpa S, Cordova A, Pignatti M, et al. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg 2011;128:892-906. https://doi.org/10.1097/PRS.0b013e3182268c83
  4. Schonauer F, Vuppalapati G, Marlino S, et al. Versatility of the posterior auricular flap in partial ear reconstruction. Plast Reconstr Surg 2010;126:1213-21. https://doi.org/10.1097/PRS.0b013e3181ec1f03
  5. Hyakusoku H, Iwakiri I, Murakami M, et al. Central axis flap methods. Burns 2006;32:891-6. https://doi.org/10.1016/j.burns.2006.03.017
  6. Bravo FG, Schwarze HP. Free-style local perforator flaps: concept and classification system. J Plast Reconstr Aesthet Surg 2009;62:602-8. https://doi.org/10.1016/j.bjps.2008.11.086
  7. Ayestaray B, Ogawa R, Ono S, et al. Propeller flaps: classification and clinical applications. Ann Chir Plast Esthet 2011; 56:90-8. https://doi.org/10.1016/j.anplas.2010.11.004
  8. Ono S, Chung KC, Hayashi H, et al. Application of multidetector- row computed tomography in propeller flap planning. Plast Reconstr Surg 2011;127:703-11. https://doi.org/10.1097/PRS.0b013e318200a99e
  9. Xu Y, Hai H, Liang Z, et al. Pedicled fasciocutaneous flap of multi-island design for large sacral defects. Clin Orthop Relat Res 2009;467:2135-41. https://doi.org/10.1007/s11999-008-0643-3
  10. Jakubietz RG, Jakubietz MG, Jakubietz DF, et al. Ischial pressure sores: reconstruction using the perforator-based reverse flow musculocutaneous 180 degrees propeller flap. Microsurgery 2009;29:672-5. https://doi.org/10.1002/micr.20678
  11. Korambayil PM, Allalasundaram K, Balakrishnan T. Perforator propeller flaps for sacral and ischial soft tissue reconstruction. Indian J Plast Surg 2010;43:151-7. https://doi.org/10.4103/0970-0358.73427
  12. Unal C, Yirmibesoglu OA, Ozdemir J, et al. Superior and inferior gluteal artery perforator flaps in reconstruction of gluteal and perianal/perineal hidradenitis suppurativa lesions. Microsurgery 2011;31:539-44. https://doi.org/10.1002/micr.20918
  13. Wagstaff MJ, Rozen WM, Whitaker IS, et al. Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps. Microsurgery 2009;29: 626-9. https://doi.org/10.1002/micr.20663
  14. Jakubietz RG, Jakubietz DF, Zahn R, et al. Reconstruction of pressure sores with perforator-based propeller flaps. J Reconstr Microsurg 2011;27:195-8. https://doi.org/10.1055/s-0030-1270537
  15. Eom JS, Hong JP. Lower back defect coverage using a freestyle gluteal perforator flap. Ann Plast Surg 2011;67:516-9. https://doi.org/10.1097/SAP.0b013e3182045823
  16. Higueras Sune MC, Lopez Ojeda A, Narvaez Garcia JA, et al. Use of angioscanning in the surgical planning of perforator flaps in the lower extremities. J Plast Reconstr Aesthet Surg 2011;64:1207-13. https://doi.org/10.1016/j.bjps.2011.03.015
  17. Oh TS, Hallock G, Hong JP. Freestyle propeller flaps to reconstruct defects of the posterior trunk: a simple approach to a difficult problem. Ann Plast Surg 2012;68:79-82. https://doi.org/10.1097/SAP.0b013e3182157940
  18. Mun GH, Jo YW, Lim SY, et al. Pedicled perforator flap of stellate design. J Plast Reconstr Aesthet Surg 2008;61:1332-7. https://doi.org/10.1016/j.bjps.2007.09.014
  19. Cheon YW, Lee MC, Kim YS, et al. Gluteal artery perforator flap: a viable alternative for sacral radiation ulcer and osteoradionecrosis. J Plast Reconstr Aesthet Surg 2010;63:642-7. https://doi.org/10.1016/j.bjps.2009.01.081
  20. Murakami M, Hyakusoku H, Ogawa R. The multilobed propeller flap method. Plast Reconstr Surg 2005;116:599-604. https://doi.org/10.1097/01.prs.0000175224.86714.05
  21. Aslan G, Tuncali D, Cigsar B, et al. The propeller flap for postburn elbow contractures. Burns 2006;32:112-5. https://doi.org/10.1016/j.burns.2005.07.007
  22. Hosny H, El-Shaer W. The eight-limb modified propeller flap: a safer new technique. Burns 2011;37:905-9. https://doi.org/10.1016/j.burns.2010.12.015
  23. Ono S, Sebastin SJ, Yazaki N, et al. Clinical applications of perforator-based propeller flaps in upper limb soft tissue reconstruction. J Hand Surg Am 2011;36:853-63. https://doi.org/10.1016/j.jhsa.2010.12.021
  24. Bhat S, Shah A, Burd A. The role of freestyle perforator-based pedicled flaps in reconstruction of delayed traumatic defects. Ann Plast Surg 2009;63:45-52. https://doi.org/10.1097/SAP.0b013e318189383d
  25. Mateev MA, Ogawa R, Trunov L, et al. Shape-modified radial artery perforator flap method: analysis of 112 cases. Plast Reconstr Surg 2009;123:1533-43. https://doi.org/10.1097/PRS.0b013e3181a07655

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