The Role of Supermicrosurgery and Arborization Capture in Improving Free-styled Propeller Flap Survival

Propeller flaps have a higher-than-normal incidence of partial flap necrosis. Although venous supercharging has been shown to reduce this risk, its application is limited outside the scope of lower limb propeller flaps. In this article, we look at the ability of arborization capture and supermicrosurgery to allow propeller flaps to capture adjacent perforasomes and significantly improve flap survival.

In a retrospective case series across two institutions, the outcomes of two groups of patients who had propeller flaps were compared. Group A patients were those who had conventional free-styled propeller flaps (n = 25), whereas Group B (n = 19) patients had propeller flaps algorithmically selected for either (1) arborization capture or (2) venous supercharging, or both. Two-way ANOVA analysis was performed to evaluate inter-group differences.

Conventional propeller flaps had a 64% complete survival rate (32% partial necrosis rate and a 4% total necrosis rate) compared with a 94% complete survival rate in modified propeller flaps. Of the 12 cases of arborization capture (perforator complex diameters of 1-2 mm), only one flap sustained partial flap loss, whereas all seven supercharged propeller flaps (selected for perforator diameter <1 mm, with venous supercharging, in addition to arborization capture) survived completely.

The arborization technique should be the mainstay technique for all propeller flaps with perforator complex diameters of less than 2 mm while supercharging further enhances its survival, particularly in perforator complex diameters of less than 1 mm.