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Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

Nikhil Panse¹, Parag Sahasrabudhe¹

¹Department of Plastic Surgery, B.J.Government Medical College & Sassoon Hospital, Pune, Maharashtra, India.

Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India

|July 3, 2014

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Free style perforator flaps offer a reliable method for upper extremity soft tissue reconstruction. Despite initial concerns, this technique shows promise for addressing defects from trauma and burns.

Area of Science:

Plastic Surgery
Microsurgery
Reconstructive Surgery

Background:

Perforator flaps, particularly freestyle perforator-based propeller flaps, faced initial skepticism in plastic surgery due to safety concerns regarding perforator twisting.
While their use in lower extremity reconstruction is increasing, applications in upper extremity reconstruction remain less frequently reported, especially in regions like the Indian subcontinent.

Purpose of the Study:

To evaluate the safety and efficacy of freestyle perforator-based propeller flaps for soft tissue reconstruction of the upper extremity.
To assess the outcomes and complication rates in a series of patients undergoing this procedure.

Main Methods:

A retrospective case series of 63 freestyle perforator flaps performed for upper extremity soft tissue reconstruction between November 2008 and June 2013.

Keywords:

Hand defects perforator based propeller flaps perforator flaps propeller flaps upper extremity wrist defects

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Data collected included patient demographics, surgical indications, defect characteristics, flap outcomes, and complications. The study was conducted by a single surgeon.

Main Results:

63 flaps were used in 62 patients, primarily for trauma (31 flaps) and post-burn sequelae (30 flaps).
A total of 8 flaps (12-13%) experienced necrosis (4 complete, 4 partial), with 7 requiring secondary procedures. Most failures occurred early in the series, suggesting a learning curve.
The overall success rate indicates the flap's potential despite initial challenges.

Conclusions:

Freestyle perforator-based propeller flaps are a dependable option for reconstructing small to moderate-sized soft tissue defects in the upper extremity.
The technique, while having a learning curve, demonstrates reliability for various indications including trauma and post-burn defects.