Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

How to Transform a Perforator Propeller Flap into a Keystone Flap in Case of Unsatisfying Perforator Vessel Local Perforator Flap Coverage in Limbs

  • Elena Ciucur (Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital) ;
  • Hadj Boukhenouna (Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital) ;
  • Benjamin Guena (Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital) ;
  • I. Garrido-Stowhas (Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital) ;
  • Christian Herlin (Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital) ;
  • Benoit Chaput (Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital)
  • Received : 2021.05.25
  • Accepted : 2021.12.30
  • Published : 2023.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Moderate soft-tissue defects need stable coverage, ideally with tissue of similar characteristics and low donor site morbidity. We propose a simple technique for the coverage of moderate skin defects in the limbs. It allows intraoperative transformation of a propeller perforator flap (PPF) into a keystone design perforator flap (KDPF) in cases of unsatisfying perforator vessel or in cases of unpredictable intraoperative events. Between March 2013 and July 2019, nine patients with moderate soft-tissue defects (mean defect size 4.5 × 7.6 cm) in the limbs (two on the upper limbs and seven on the lower limbs) were covered using this technique. We performed four PPFs and five KDPFs. The mean follow-up was 5 months. There was one complication, partial distal tip necrosis in a PPF located in the leg, which healed by secondary intention within 3 weeks. The donor site was closed directly in all cases. No functional impairments were noted regardless of the perforator flap utilized. This technique enables us to employ flexible surgical strategies and allows us to make adjustments based on the patient's vascular anatomy.

Keywords

References

  1. Paik JM, Pyon J-K. Risk factor analysis of freestyle propeller flaps. J Reconstr Microsurg 2017;33(01):26-31  https://doi.org/10.1055/s-0036-1586748
  2. Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects. Plast Reconstr Surg 2016;137(01):314-331  https://doi.org/10.1097/PRS.0000000000001891
  3. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 2003;73(03):112-120  https://doi.org/10.1046/j.1445-2197.2003.02638.x
  4. Mun GH, Jeon BJ. An efficient method to increase specificity of acoustic Doppler sonography for planning a perforator flap: perforator compression test. Plast Reconstr Surg 2006;118(01):296-297  https://doi.org/10.1097/01.prs.0000222221.88939.58
  5. Huang J, Yu N, Long X, Wang X. A systematic review of the keystone design perforator island flap in lower extremity defects. Medicine (Baltimore) 2017;96(21):e6842 
  6. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991;44(01):53-54  https://doi.org/10.1016/0007-1226(91)90179-N
  7. Pignatti M, Ogawa R, Hallock GG, et al. The "Tokyo" consensus on propeller flaps. Plast Reconstr Surg 2011;127(02):716-722  https://doi.org/10.1097/PRS.0b013e3181fed6b2
  8. Mohan AT, Sur YJ, Zhu L, et al. The concepts of propeller, perforator, keystone, and other local flaps and their role in the evolution of reconstruction. Plast Reconstr Surg 2016;138(04):710e-729e  https://doi.org/10.1097/PRS.0000000000002610
  9. Pauchot J, Chambert J, Remache D, Elkhyat A, Jacquet E. Geometrical analysis of the V-Y advancement flap applied to a keystone flap. J Plast Reconstr Aesthet Surg 2012;65(08):1087-1095  https://doi.org/10.1016/j.bjps.2012.03.004
  10. Pelissier P, Santoul M, Pinsolle V, Casoli V, Behan F. The keystone design perforator island flap. Part I: anatomic study. J Plast Reconstr Aesthet Surg 2007;60(08):883-887  https://doi.org/10.1016/j.bjps.2007.01.072
  11. Mohan AT, Rammos CK, Akhavan AA, et al. Evolving concepts of keystone perforator island flaps (KPIF): principles of perforator anatomy, design modifications, and extended clinical applications. Plast Reconstr Surg 2016;137(06):1909-1920  https://doi.org/10.1097/PRS.0000000000002228
  12. Yoon CS, Kim SI, Kim H, Kim KN. Keystone-designed perforator island flaps for the coverage of traumatic pretibial defects in patients with comorbidities. Int J Low Extrem Wounds 2017;16(04):302-309  https://doi.org/10.1177/1534734617740971
  13. Darrach H, Kokosis G, Bridgham K, Stone JP, Lange JR, Sacks JM. Comparison of keystone flaps and skin grafts for oncologic reconstruction: a retrospective review. J Surg Oncol 2019;119(07):843-849  https://doi.org/10.1002/jso.25394
  14. Sorooshian P, King I, Dunkin C. Keystone island flaps for reconstruction following lower leg skin cancer resection: a comparison with split-thickness skin grafts. J Plast Reconstr Aesthet Surg 2019;72(03):513-527  https://doi.org/10.1016/j.bjps.2018.12.016
  15. Colorado Cogolludo L, Conde-Taboada A, Gonzalez-Guerra E, et al. Keystone flap used on the legs: case series. Clin Exp Dermatol. Actas Dermosifiliogr 2019;44(06):619-693  https://doi.org/10.1111/ced.13860
  16. Lese I, Grobbelaar AO, Sabau D, Georgescu AV, Constantinescu MA, Olariu R. The propeller flap for traumatic distal lower-limb reconstruction: risk factors, pitfalls, and recommendations. J Bone Joint Surg Am 2020;102(06):510-518 https://doi.org/10.2106/JBJS.19.00648