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

Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propel...

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Main Authors: Nikhil Panse, Parag Sahasrabudhe
Format: Article
Language:English
Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2014-01-01
Series:Indian Journal of Plastic Surgery
Subjects:
Online Access:http://www.ijps.org/article.asp?issn=0970-0358;year=2014;volume=47;issue=1;spage=77;epage=84;aulast=Panse
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author Nikhil Panse
Parag Sahasrabudhe
author_facet Nikhil Panse
Parag Sahasrabudhe
author_sort Nikhil Panse
collection DOAJ
description Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV.
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spelling doaj-art-2ce9f3aba2ea49d2955a9100005e9dfb2025-08-20T02:01:34ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Plastic Surgery0970-03581998-376X2014-01-01471778410.4103/0970-0358.129628Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!Nikhil PanseParag SahasrabudheBackground: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV.http://www.ijps.org/article.asp?issn=0970-0358;year=2014;volume=47;issue=1;spage=77;epage=84;aulast=PanseHand defectsperforator flapspropeller flapsperforator based propeller flapsupper extremitywrist defects
spellingShingle Nikhil Panse
Parag Sahasrabudhe
Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
Indian Journal of Plastic Surgery
Hand defects
perforator flaps
propeller flaps
perforator based propeller flaps
upper extremity
wrist defects
title Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
title_full Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
title_fullStr Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
title_full_unstemmed Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
title_short Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!
title_sort free style perforator based propeller flaps simple solutions for upper extremity reconstruction
topic Hand defects
perforator flaps
propeller flaps
perforator based propeller flaps
upper extremity
wrist defects
url http://www.ijps.org/article.asp?issn=0970-0358;year=2014;volume=47;issue=1;spage=77;epage=84;aulast=Panse
work_keys_str_mv AT nikhilpanse freestyleperforatorbasedpropellerflapssimplesolutionsforupperextremityreconstruction
AT paragsahasrabudhe freestyleperforatorbasedpropellerflapssimplesolutionsforupperextremityreconstruction