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Moshrefi et al. Propeller flaps for trunk wounds

As is true of most plastic surgery, the propeller flap discrepancy between the total number of flaps utilized
can be utilized in essentially any part of the body so and the total number of defects was that in some
long as plastic surgical principles are adhered to and cases more than one propeller flap was utilized for
meticulous surgical attention is directed toward flap reconstruction of a site.
design, dissection, and ultimately to reconstruction.
While clinical application is broad, the focus of this Etiologies of the defects addressed resulted
article is in review of propeller flaps for trunk wound from burns, wounds, pressure sores, hidradenitis
reconstruction. suppuritiva, hardware exposures, keloids and/or scars,
myelomeningoceles, pseudomeningoceles, pilonidal
METHODS disease, radiation wounds, and cancers of various
types. One case had an unspecified cause of the
A PubMed Booleansearch was conducted searching defect. Overall, cancer excision wounds were by far
the most prevalent with 105 cases (59.0%). Defect
for the terms “trunk wound propeller flap”, “trunk sizes of those specified in the articles ranged from
propeller flap”, and “freestyle trunk wound flap”. The [3-23]
results of this search were compiled and duplicates 2 cm × 5 cm to 30 cm × 24 cm. Please see Table 1
excluded. The remaining publications were vetted for the breakdown of each etiology related to each
based on the inclusion and exclusion criteria noted defect for each included study in the review.
below. The publications were then reviewed in detail.
Perforators for the flaps were identified most
Inclusion criteria for this study were that the studies commonly by handheld Doppler ultrasound. Other
be a case study, case report, case series, clinical trial, methods of perforator identification included color
reply to another study with new patient data, cohort Doppler ultrasonography (CDU), combined laser
analysis, or other retrospective or prospective studies Doppler spectrophotometry, computed tomography
identifying trunk wounds as the reconstructive defect. angiography (CTA), and dissection with visual
Additionally, a propeller flap had to be utilized for identification and palpation. Some studies did not
surgical reconstruction. Exclusion criteria for the study specify the method of perforator identification. Of the
were that the publication was not entirely in the English studies that specified flap dimensions, the propeller
language, publication not reproducibly accessed, flaps ranged from 4 cm × 6 cm to 30 cm × 17 cm.
paper did not provide enough detail regarding surgical
intervention to determine if propeller flap technique Of the 190 propeller flaps identified, 63 total
was utilized, pedicled perforator flaps were not utilized complications were identified. The most common
in propeller fashion, or that the paper was primarily a complication was 48 total cases of transient venous
review of the literature. congestion (25.3%). The second most common
complication was partial flap necrosis (6.3%). No total
RESULTS flap loss was noted. There were 2 cases of seroma
(1.1%) and 1 case of wound breakdown (0.5%).

The results of the PubMed online search yielded DISCUSSION
49 publications. After excluding duplicates, 35
publications remained. These 35 were reviewed
in detail and the publications vetted based on the The propeller flap concept and technique has
inclusion and exclusion criteria noted above. Twenty- continued to evolve in idea and application. The
onearticles remained for further in-depth review. benefits of utilizing a propeller flap include locoregional
reconstruction, reliable anatomy based upon the
Of these 21 articles, 13 articles were case series, 8 angiosome and perforasome concepts [24] , minimization
articles were case studies/reports, and no clinical trials of donor site morbidity, and design that is largely
or cohort studies were identified. The oldest article limited only by ability to close primarily.
found in the search dated back to August 2009.
The evolution of the propeller flap has included
A total of 365 flaps were described collectively multiple modifications both in application and
amongst the included studies. Among them, 190 technique. Papers indicating flap degrees of rotation
propeller flaps addressing trunk defects were less than 180 degrees were described and utilized
performed across all studies reviewed to address a successfully. Some series utilized this as a workhorse
total of 165 defects of the trunk: 14 abdomen, 101 in propeller flap reconstruction for trunk wounds.
back, 50 chest defects and adjacent respective
flaps were utilized for surgical reconstruction. The Reviewing the data from the series, it is interesting
Plastic and Aesthetic Research ¦ Volume 4 ¦ November 30, 2017 205