The Assessment of Postoperative Patency and Flow Pattern of Twisted Vascular Pedicle in Propeller Perforator Flaps in Lower Extremities Reconstruction

Abstract

he propeller perforator flap is a variant of perforator flaps in which complete skeletonization of the perforator with venae commitantes is done to transfer the islanded flap on its pedicle with up to 180 degrees of twisting that predispose to its gradual occlusion by time. These flaps have been recently advocated for lower extremity reconstruction. The relevance of a patent vascular pedicle of perforator flaps varies according to the flap type and the recipient site. Generally, in the free perforator flaps the anastomosed pedicle remains patent and provides most of the blood supply up to 10 years postoperatively. Thus, the alteration of the vessel by performing a microsurgical anastomosis does not induce architectural changes in the vessel wall causing a gradual obliteration. In the pedicled propeller perforator flaps that are mobilized solely on a twisted pedicle, the same concept may apply, rotation of the vascular pedicle may induce remodeling and intimal thickening of the vessel wall leading to gradual occlusion of the vascular pedicle that will be reflected on the flow pattern within the pedicle.The critical time after which the flap becomes independent on the pedicle due to sufficient sub-dermal perfusion and from the wound bed is still a matter of debate.