Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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The Preoperative Planning, Design, and Execution of the Freestyle Propeller Flap: A Detailed Description and the Case Series

  • Hyung Bae Kim (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seong John Han (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joon Pio Hong (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hyunsuk Peter Suh (Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2024.10.06
  • Accepted : 2025.04.16
  • Published : 2025.07.15
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Abstract

Background Propeller flap reconstruction has been widely utilized in soft tissue reconstruction due to its versatility and aesthetic outcomes. However, technical challenges and the risk of complications persist. This study aims to provide detailed guidelines on the preoperative planning, intraoperative considerations, and execution of propeller flap surgery to reduce complications. Methods A retrospective review was conducted on 20 consecutive patients undergoing propeller flap reconstruction between January 2018 and December 2020. Preoperative planning involved computed tomography (CT) angiography and color Doppler ultrasound. Flap designs prioritized perforator proximity (<3 cm from the defect), vessel axiality, and tissue laxity assessed by skin pinch tests. Surgical techniques including pedicle skeletonization, flap elevation, rotation, and inset were meticulously followed. Results No total flap loss occurred. Partial flap loss was observed in one case (5%). Two flaps (10%) exhibited venous congestion, which resolved following leech therapy without necrosis. Defects were predominantly located on the trunk (80%), with malignancy as the primary cause (55%). Mean follow-up duration was 432 days. Conclusions Careful preoperative planning and adherence to meticulous surgical techniques can significantly reduce complications in propeller flap reconstruction. This structured approach offers a reliable framework, particularly beneficial for surgeons less familiar with propeller flap techniques.

Keywords

References

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