Flap design and clinical applications of the pre-expanded perforator propeller flap / 中华整形外科杂志

ABSTRACT

Objective@#To explore the feasibility and technical tips of defect reconstruction using the pre-expanded perforator propeller (PEPP) flap.@*Methods@#From July 2009 to December 2017, 56 patients underwent defect reconstruction using the PEPP flap. During the first-stage operation, an expander with appropriate size was buried within a soft-tissue pocket. Three strategies were used for expander placement, including placement of the expander underneath the muscle, at a distance from the emergence point of the perforator when the perforator location is relatively fixed, and following the criteria when a free-style perforator flap is designed. At the second-stage operation, a PEPP flap was raised and rotated a certain number of degrees to reconstruct the defect.@*Results@#56 flaps were elevated. The expanders were buried according to the strategy Ⅰ in 2 cases, the strategy Ⅱ in 42 cases, and the strategy Ⅲ in 12 cases. The flap size ranged from 7-13 cm to 14-32 cm with the average size of 9.38 cm × 21.22 cm. The pedicle length ranged from 2.5 cm to 10 cm and the mean length was 5.03 cm. The rotation angle was 180 degrees in 44 cases, 150 and 120 degrees in 6 cases respectively. The perforators that were previously explored were all identified during the second-stage operation. 53 flaps survived completely. Venous congestion of the distal portion of the flap was observed after the surgery in two cases. Necrosis of small area of the flap occurred and free skin grafting was used to resurface the defect after debridement. All patients were followed up for 3 months to 4 years and the average follow-up time was 13.4 months.@*Conclusions@#The PEPP flap can not only ensure primary closure of the donor site, but also provide more extra tissue for defect reconstruction. For selected patients, it could be an alternative option for soft-tissue defect reconstruction.