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. 2019 Mar;46(2):176-180.
doi: 10.5999/aps.2018.00983. Epub 2019 Mar 31.

The flip-flap puzzle flap: Another recycling option

Silvia Gandolfi  1 , Raphael Carloni  2 , Matthieu Gilleron  3 , Albane Bonmarchand  1 , Isabelle Auquit-Auckbur  1
Affiliations

The flip-flap puzzle flap: Another recycling option

Silvia Gandolfi et al. Arch Plast Surg. 2019 Mar.

Abstract

Post-traumatic soft tissue defects sometimes require sequential flap coverage to achieve complete healing. In the era of propeller flaps, which were developed to reduce donor site morbidity, Feng et al. introduced the concept of the free-style puzzle flap, in which a previously harvested flap becomes its own donor site by recycling the perforator. However, when a perforator cannot be found with a Doppler device, we suggest performing a new type of flap, the flip-flap puzzle flap, which combines two concepts: the free-style puzzle flap and the flip-flap flap described by Voche et al. in the 1990s. We present the cases of three patients who achieved complete healing through this procedure.

Keywords: Extremities; Perforator flaps; Reconstructive surgical procedures; Soft tissue injuries; Surgical flaps.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.. Schematic representation of the flip-flap puzzle-flap procedure
Fig. 2.
Fig. 2.. Flip-flap puzzle flap for case 1
(A) Figure A shows the preoperative view of the patient’s forearm with a distal necrosis of a radial collateral artery perforator (RCAP)-based perforator flap. (B) Figure B shows the immediate postoperative view of a flip-flap puzzle flap harvested from the interosseous posterior flap (a, donor site on the interosseous posterior flap; b, flip-flap puzzle flap; c, RCAP-based propeller flap).
Fig. 3.
Fig. 3.. Flip-flap puzzle flap for case 2
(A) Figure A shows the preoperative view of the patient’s ankle (a, sural neurocutaneous flap; b, internal plantar flap with necrosis of its distal part). (B) Figure B shows the postoperative view at day 2 of the flip-flap puzzle flap harvested from the sural neurocutaneous flap (a, sural neurocutaneous flap; b, flip-flap puzzle flap covered with a skin graft; c, internal plantar flap). (C) Figure C shows the postoperative view at 1 month.
Fig. 4.
Fig. 4.. Flip-flap puzzle flap for case 3
(A) Figure A shows the preoperative view of the patient’s ankle (a, anterior tibial artery propeller flap; b. distal necrosis of the flap exposing the talus bone). (B) Figure B shows the postoperative view at day 7 of the flip-flap puzzle flap harvested from the anterior tibial artery propeller flap (a, anterior tibial artery propeller flap; b, flip-flap puzzle flap covered with a skin graft).
See this image and copyright information in PMC

References

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