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Dual-perforator Pedicled Propeller Flap With a Deep Adipofascial Bridge for Extremity Reconstruction
Haihua Huang1, Zeyong Wu2, Jinbiao Zheng1
1From the Department of Plastic Surgery, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, Guangdong, China.
This study introduces a dual-perforator propeller flap with an adipofascial bridge for extremity reconstruction. This refined technique improves venous drainage and flap viability, reducing complications like congestion and necrosis.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Microsurgery
Background:
- Pedicled propeller flaps are common for extremity reconstruction but often suffer from venous congestion and necrosis.
- Existing modifications to improve venous drainage can limit flap mobility or add technical complexity.
Purpose of the Study:
- To introduce and evaluate a refined dual-perforator pedicled propeller flap technique with a deep adipofascial bridge.
- To enhance venous outflow and flap viability in extremity reconstruction.
Main Methods:
- A dual-perforator propeller flap technique was used, identifying two perforators (P1, P2) from a single source vessel.
- A deep adipofascial bridge was preserved between perforators to create a composite pedicle.
- The flap was transposed using a propeller mechanism in 31 patients.
Main Results:
- All 31 flaps were successfully transposed with a 12.9% rate of postoperative venous congestion.
- Three cases of congestion resolved spontaneously; one case resulted in minor tip necrosis (1% partial flap loss) that healed conservatively.
- All other flaps achieved complete survival with satisfactory functional and aesthetic outcomes.
Conclusions:
- The dual-perforator propeller flap with an adipofascial bridge improves vascular perfusion and venous outflow.
- This modification enhances flap reliability, increases rotation arc, and reduces venous congestion risk.
- It offers a robust nonmicrosurgical option for complex extremity reconstruction.
