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Open Access
CC BY 4.0 · Arch Plast Surg 2025; 52(04): 239-246
DOI: 10.1055/a-2620-3297
Extremity/Lymphedema
Original Article

The Preoperative Planning, Design, and Execution of the Freestyle Propeller Flap: A Detailed Description and the Case Series

Hyung Bae Kim 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Seong John Han 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Joon Pio Hong 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
,
Hyunsuk Peter Suh 
1   Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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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

propeller flap - soft tissue reconstruction - trunk - lower extremities

Authors' Contributions

H.P.S. and H.B.K. conceptualized the study. H.B.K. and S.J.H. conducted the literature review and data extraction. All authors contributed to the interpretation of results and manuscript writing. All authors reviewed and approved the final manuscript.


Ethical Approval

This retrospective study, approved by the Institutional Review Board (No. 2025-0099).


Patient Consent

Written informed consent was obtained from all patients for the publication of their clinical photographs.




Publication History

Received: 06 October 2024

Accepted: 16 April 2025

Accepted Manuscript online:
26 May 2025

Article published online:
23 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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