Utilization of two methods assisting perforator identification for brachial artery perforator propeller flap...

Area of Science:

• Plastic Surgery
• Microsurgery
• Anatomy

Background:

• The brachial artery perforator propeller (BAPP) flap combines advantages of local and perforator flaps.
• Underutilization of BAPP flaps is partly due to anatomical variations in medial arm perforators.

Purpose of the Study:

• To review preliminary experience with two methods for BAPP flap perforator localization.
• To evaluate the ABC system and indocyanine green angiography (ICGA) for preoperative perforator identification.
• To determine optimal examination modes based on clinical settings.

Main Methods:

• Utilized a refined coordinate system (ABC system) and ICGA for perforator localization in 22 patients undergoing BAPP flap reconstruction.
• Compared the efficacy and limitations of the ABC system and ICGA.
• Selected optimal methods based on specific clinical scenarios.

Main Results:

• The ABC system localized 31 perforators preoperatively in 22 flaps; only two were not visualized during surgery.
• ICGA identified 27 perforators in six pre-expanded flaps, all visualized during surgery.
• ICGA reconfirmed perforators previously identified by the ABC system.

Conclusions:

• Both the ABC system and ICGA are valuable tools for preoperative perforator localization in BAPP flap transfers.
• Each method has limitations, but they are complementary for safe and effective flap elevation.
• Selecting the optimal method based on clinical settings is recommended for BAPP flap surgery.