Single perforator greater saphenous neuro‐veno‐fasciocutaneous propeller flaps for lower extremity reconstructions

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Excerpt

The lack of soft tissue that is available for medial leg and foot defect reconstructions presents a challenge for plastic surgeons. Using free flaps for reconstruction requires microanastomosis skills that cause large thrombosis risks and spasms. Many local flaps fall short of expectations regarding their reliability, mainly because of the paucity of spare tissues, especially on the lower third of the leg. Proten first introduced the fasciocutaneous flap, which significantly improved the length : width ratio.1 Despite the important advent of the fasciocutaneous flap, some surgeons criticized the unsightly dog‐ears of these cutaneous‐pedicled flaps, and they had a high necrosis rate of 25%, which was demonstrated by Chatre and Quaba.2 Other surgeons found that subcutaneous pedicles were too thick and that they restricted the flap rotation to no more than 90 degrees, which limited its application.
As the propeller flap concept was first raised by Hyakusoku et al. in 1991, and updated by Hallock in 2006, in which the perforator flap definition became based on a single perforator vessel and could be rotated 180 degrees,3 the propeller flap has shown great flexibility advantages regarding movement and less donor site comorbidity.
In a series of studies, we made modifications to the saphenous neurofasciocutaneous perforator flap by skeletonizing the perforator and dissecting the flap as an island flap, which improved the venous flow and pedicle twisting. We therefore conducted a clinical study to examine the vascularization and venous flow of a single perforator pedicled greater saphenous neuro‐veno‐fasciocutaneous propeller flap. The results illustrated that it was reliable to base the flap on only a single perforator, which also facilitated two unequal limbs of the propeller to rotate up to 180 degrees so that the longer limb could easily fill the defects. The short limb can assist with the donor defect site closure by decreasing tension and avoiding excessive pressure on the pedicle, which also enhances the aesthetic result. The vessel axis, which consists of the great saphenous vein and the saphenous nerve, was shown to improve the blood supply to the distal area of the flap. In clinical practice, the venous flow problem that is caused by venous hypertension was solved by including the segmental great saphenous vein into the flap base.
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