Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
Microsurgery. 2020 Feb;40(2):252-257. doi: 10.1002/micr.30497. Epub 2019 Jul 18.
Despite some ongoing criticisms, propeller flaps are still gaining popularity among plastic surgeons. The need of skin grafting of the donor site is one of those limitations that sometime affect the beauty and the efficacy of this reconstructive technique. Similar to a classic bi-lobed skin flap in which the second lobe of the same flap is mobilized to cover the donor site defect of the first lobe, a second, discrete propeller flap can be harvested adjacent to the first, in order to close the first donor site defect, thus avoiding the need for a skin graft. We applied this concept of "sequential" propeller flaps to cover a 4.5 × 4 cm full thickness soft tissue defect at the level of the heel in a 54-year-old patient who underwent melanoma excision and sentinel node biopsy.The first and second propeller flaps of 10 × 4.5 cm respectively were rotated on a distal and on a more proximal perforator of the posterior tibial artery (PTA) respectively, obtaining a tension free closure along the entire wound. The post-operative course was uneventful and the patient returned to full normal activities after 4 weeks. Follow up at 6 months showed a stable reconstruction with no functional deficit. This option, that relies on two separate perforator propeller flaps performed in sequence to obtain complete wound closure, may be kept in mind when dealing with soft tissue defects eligible for propeller flap reconstruction, as long as sizeable perforators in a favorable position are available. Moreover, a brief literature review on propeller flap use in flap donor site closure is also provided.
尽管存在一些持续的批评，但推进皮瓣在整形医生中仍然越来越受欢迎。供区植皮的需求是限制该重建技术美观和效果的因素之一。类似于经典的双叶皮瓣，即通过移动同一皮瓣的第二个叶瓣来覆盖第一个叶瓣的供区缺损，也可以在第一个皮瓣旁边收获第二个独立的推进皮瓣，以封闭第一个供区缺损，从而避免植皮的需要。我们将这种“序贯”推进皮瓣的概念应用于一位 54 岁患者，该患者接受了黑色素瘤切除术和前哨淋巴结活检，在足跟水平有一个 4.5×4cm 的全层软组织缺损。第一个和第二个推进皮瓣分别为 10×4.5cm，分别以远端和更近端的胫后动脉（PTA）穿支旋转，在整个伤口处实现无张力闭合。术后过程顺利，患者在 4 周后恢复了正常活动。6 个月随访显示重建稳定，无功能缺陷。这种方法依赖于两个单独的穿支推进皮瓣序贯进行，以获得完全的伤口闭合，在处理适合推进皮瓣重建的软组织缺损时可以考虑使用，只要有位置良好的足够大的穿支即可。此外，还提供了关于推进皮瓣在皮瓣供区关闭中应用的文献综述。
