Direction of Flap Rotation in Propeller Flaps: Does It Really Matter?

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Propeller flaps are widely used in reconstructive surgery.
• The optimal rotation direction for propeller flaps is not well-established.
• Investigating flap pedicle velocity and flow is crucial for surgical success.

Purpose of the Study:

• To evaluate the effect of 180° propeller flap rotation on pedicle velocity and flow.
• To determine if a "preferable" rotating direction exists for propeller flaps.
• To compare surgical outcomes between flaps with and without a selected preferable rotation direction.

Main Methods:

• Part 1: Assessed flap pedicle velocity and flow in neutral, counterclockwise, and clockwise positions for 29 flaps.
• Data categorized into neutral, high-value, and low-value groups for analysis.
• Part 2: Compared outcomes of a prospective study using a preferred rotation against historical controls (29 patients).

Main Results:

• Mean velocity and volume were significantly higher in the high-value group compared to the low-value group (p=0.0001).
• While not statistically significant, the preferable rotation group showed fewer flap losses and wound dehiscences compared to the non-selected group.
• The high-value group demonstrated significantly greater perforator velocity and volume.

Conclusions:

• Flap rotation direction significantly influences pedicle velocity and flow.
• Utilizing a preferred rotation direction with higher velocity and flow may enhance propeller flap outcomes.
• This optimization is particularly relevant for larger flap reconstructions.