Current data on upper extremity propeller flaps are poor and do not allow the assessment of the safety of this technique. A systematic literature review was conducted searching PubMed, EMBASE, and the Cochrane Library electronic databases, and the selection process was adapted from the preferred reporting items for systematic reviews and meta-analysis statement. The final analysis included ten relevant articles involving 117 flaps. The majority of flaps were used for the hand, distal wrist, and elbow. The radial artery perforator and ulnar artery perforator were the most frequently used flaps. The were 7% flaps with venous congestion and 3% with complete necrosis. No difference in complications rate was found for different flaps sites. Perforator-based propeller flaps appear to be an interesting procedure for covering soft tissue defects involving the upper extremities, even for large defects, but the procedure requires experience and close monitoring.
AlharbiMPerignonDAssafNQassemyarQElsamadYSinnaR. Application of the inner arm perforator flap in the management of axillary hidradenitis suppurativa. Ann Chir Plast Esthet. 2014, 59: 29–34.
2.
AndreABonnevialleNGrolleauJLMansatP. Soft-tissue coverage of olecranon with musculocutaneous flexor carpi ulnaris flap. Orthop Traumatol Surg Res. 2014, 100: 963–6.
3.
ArtiacoSBattistonBColzaniG. Perforator based propeller flaps in limb reconstructive surgery: clinical application and literature review. BioMed Res Int. 2014, 690649.
4.
BekaraFHerlinCMojallalL. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: identification of risk factors for complications. Plast Reconstr Surg. 2015, 137: 314–31.
5.
BekaraFHerlinCSomdaSde RunzAGrolleauJLChaputB. Free versus perforator-pedicled propeller flaps in lower extremity reconstruction: what is the safest coverage? A meta-analysis. Microsurgery. Epub ahead of print 28March2016. DOI: 10.1002/micr.30047.
6.
BhatSShahABurdA. The role of freestyle perforator-based pedicled flaps in reconstruction of delayed traumatic defects. Ann Plast Surg. 2009, 63(1): 45–52.
7.
BilginSSTopalanMIpWYChowSP. Effect of torsion on microvenous anastomotic patency in a rat model and early thrombolytic phenomenon. Microsurgery. 2003, 23: 381–6.
8.
BravoFGSchwarzeHP. Free-style local perforator flaps: concept and classification system. J Plast Reconstr Aesthetic Surg. 2009, 62: 602–8.
9.
ChaputBBertheuilNGandolfiSGrolleauJLHerlinC. Perforator detection with a hand-held Doppler device: importance of the learning curve. Burns. 2015a, 41: 197.
10.
ChaputBGandolfiSHo QuocCChavoinJPGarridoIGrolleauJL. Reconstruction of cubital fossa skin necrosis with radial collateral artery perforator-based propeller flap (RCAP). Ann Chir Plast Esthet. 2014, 59: 65–9.
11.
ChaputBHerlinCBekaraFBertheuilN. Thinning: the difference between free and propeller perforator flaps. Arch Plast Surg. 2015b, 42: 241–2.
12.
CortenKStruelensBEvansBGrahamEBourneRBMacDonaldSJ. Gastrocnemius flap reconstruction of soft-tissue defects following infected total knee replacement. Bone Joint J. 2013, 95-B: 1217–21.
13.
D’ArpaSCordovaAPignattiMMoschellaF. Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases. Plast Reconstr Surg. 2011, 128: 892–906.
14.
DumitrascuDIMateiIRCapotaIMOlariuOOpincariuIGeorgescuAV. Elbow defects reconstruction using pedicled perforator flaps. Rom J Morphol Embryol. 2015, 56: 937–41.
15.
EburderyHGrolleauJLBerthierCBertheuilNChaputB. Management of large sternal wound infections with the superior epigastric artery perforator flap. Ann Thorac Surg. 2016, 101: 375–7.
16.
GirPChengAOniGMojallalASaint-CyrM. Pedicled-perforator (propeller) flaps in lower extremity defects: a systematic review. J Reconstr Microsurg. 2012, 28: 595–601.
17.
GiuntaREGeisweidAFellerAM. The value of preoperative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg. 2000, 105: 2381–6.
18.
GuptaALakhianiCLimBH. Free tissue transfer to the traumatized upper extremity: risk factors for postoperative complications in 282 cases. J Plast Reconstr Aesthet Surg. 2015, 68: 1184–90.
19.
HallockGG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg. 2006, 56: 540–2.
20.
HarrisonBLLakhianiCLeeMRSaint-CyrM. Timing of traumatic upper extremity free flap reconstruction: a systematic review and progress report. Plast Reconstr Surg. 2013, 132: 591–6.
21.
HelgesonMDPotterBKEvansKNShawenSB. Bioartificial dermal substitute: a preliminary report on its use for the management of complex combat-related soft tissue wounds. J Orthop Trauma. 2007, 21: 394–9.
22.
HongJPChoiDHSuhH. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg. 2014, 30: 491–6.
23.
HsuC-CLinY-TLinC-HLinC-HWeiF-C. Immediate emergency free anterolateral thigh flap transfer for the mutilated upper extremity. Plast Reconstr Surg. 2009, 123: 1739–47.
24.
InnocentiMMenichiniGBaldrighiCDelcroixLVigniniLTosP. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction?Clin Orthop. 2014, 472: 2276–86.
25.
JakubietzRGJakubietzMGGruenertJGKlossDF. The 180-degree perforator-based propeller flap for soft tissue coverage of the distal, lower extremity: a new method to achieve reliable coverage of the distal lower extremity with a local, fasciocutaneous perforator flap. Ann Plast Surg. 2007, 59: 667–71.
26.
LazzeriDHuemerGMNicoliF. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: a systematic review. Arch Plast Surg. 2013, 40: 44–50.
ListerGSchekerL. Emergency free flaps to the upper extremity. J Hand Surg. 1988, 13: 22–8.
29.
MateevMAKuokkanenHOM. Reconstruction of soft tissue defects in the extremities with a pedicled perforator flap: series of 25 patients. J Plast Surg Hand Surg. 2012, 46: 32–36.
30.
MilcheskiDAChangAALobatoRCNakamotoHATumaPFerreiraMC. Coverage of deep cutaneous wounds using dermal template in combination with negative-pressure therapy and subsequent skin graft. Plast Reconstr Surg Glob Open. 2014, 2: e170.
MoherDLiberatiATetzlaffJAltmanDG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg Lond Engl. 2010, 8: 336–41.
33.
MoscatielloFMasiàJCarreraAClaveroJALarrañagaJRPonsG. The “propeller” distal anteromedial thigh perforator flap. Anatomic study and clinical applications. J Plast Reconstr Aesthetic Surg. 2007, 60: 1323–30.
34.
MurakamiMOnoSIshiiNHyakusokuH. Reconstruction of elbow region defects using radial collateral artery perforator (RCAP)-based propeller flaps. J Plast Reconstr Aesthetic Surg. 2012, 65: 1418–21.
35.
NelsonJAFischerJPBrazioPSKovachSJRossonGDRadAN. A review of propeller flaps for distal lower extremity soft tissue reconstruction: is flap loss too high?Microsurgery. 2013, 33: 578–86.
36.
OnoSSebastinSJYazakiNHyakusokuHChungKC. Clinical applications of perforator-based propeller flaps in upper limb soft tissue reconstruction. J Hand Surg. 2011, 36: 853–63.
37.
PanseNSahasrabudheP. Free style perforator based propeller flaps: simple solutions for upper extremity reconstruction! Indian J Plast Surg Off Publ Assoc Plast Surg India. 2014, 47: 77–84.
38.
RehimSASinghalMChungKC. Dermal skin substitutes for upper limb reconstruction: current status, indications, and contraindications. Hand Clin. 2014, 30: 239–52.
39.
SauerbierMGermannGGiesslerGASedigh SalakdehMDöllM. The free lateral arm flap-a reliable option for reconstruction of the forearm and hand. Hand (NY). 2012, 7: 163–71.
40.
SteiertAEGohritzASchreiberTCKrettekCVogtPM. Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure therapy – worse or worth?J Plast Reconstr Aesthetic Surg. 2009, 62: 675–83.
41.
StevanovicMSharpeF. Soft-tissue coverage of the elbow. Plast Reconstr Surg. 2013, 132: 387e–402e.
42.
SundineMSchekerLR. A comparison of immediate and staged reconstruction of the dorsum of the hand. J Hand Surg Edinb Scotl. 1996, 21: 216–21.
43.
TarasJSSapienzaARoachJBTarasJP. Acellular dermal regeneration template for soft tissue reconstruction of the digits. J Hand Surg. 2010, 35: 415–21.
