Propeller Flaps

Abstract

A propeller flap is an islanded flap that reaches the recipient site through an axial rotation around its vascular axis. The degree of rotation varies from 90 degrees to 180 degrees. It is a highly reliable local reconstructive option. These flaps are simple, single-stage, easy to harvest, and not constrained by routine length-to-width ratios. Since their introduction, the technique has continued to evolve and more applications for the use of propeller flaps are being explored. In spite of their growing use in clinical practice in recent years, many reconstructive surgeons are unaware of their versatility, unsure of their safety, and apprehensive about using propeller flaps confidently. This article aims at understanding the nomenclature, key principles, biogeometry and planning, operative technical details, applications, and complications of propeller flaps.

Keywords: biogeometry; extremity flaps; head and neck flaps; local flap; perforator flap; post-burn reconstruction; propeller flap.

Fig. 1

Propeller flap biogeometry.

Fig. 2

Intraoperative photography tips.

Fig. 3

( a ) Malignant lesion. ( b ) Primary defect over the face. ( c ) Axial rotation of propeller flap based on facial artery perforators through 180°. ( d ) Well-settled propeller flap. (Note: absence or minimal pincushion effect).

Fig. 4

( a ) Soft tissue defect over the volar wrist. ( b ) Islanded flap. ( c ) Skeletonized perforator. ( d ) Flap propelled into the defect. ( e ) Well-settled flap with linear closure of donor site.

Fig. 5

( a ) Defect over the back. ( b ) Planned free-style propeller flap. ( c ) Well-settled flap. (Courtesy: Dr. Dushyant Jaiswal, Consultant Plastic, Reconstructive and Microvascular Surgeon at Tata Memorial Hospital, Mumbai.)

Fig. 6

( a ) Post burn wrist contracture with tissue deficit. ( b ) Primary defect and perforator propeller flap based on ulnar artery perforator (note: suprafascial harvest of flap). ( c ) Well-settled flap with linear closure of donor site.