J Reconstr Microsurg 2015; 31(04): 261-267
DOI: 10.1055/s-0034-1395994
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Freestyle Multiple Propeller Flap Reconstruction (Jigsaw Puzzle Approach) for Complicated Back Defects

Sung Woo Park
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Tae Suk Oh
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Jin Sup Eom
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Yoon Chi Sun
2   Department of Plastic Surgery, Ulsan University Hospital, University of Ulsan, Seoul, Korea
Hyun Suk Suh
3   Department of Plastic Surgery, Ewha Womans University Hospital, Seoul, Korea
Joon Pio Hong
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
› Author Affiliations
Further Information

Publication History

09 June 2014

21 September 2014

Publication Date:
13 March 2015 (online)


Background The reconstruction of the posterior trunk remains to be a challenge as defects can be extensive, with deep dead space, and fixation devices exposed. Our goal was to achieve a tension-free closure for complex defects on the posterior trunk.

Patients and Methods From August 2006 to May 2013, 18 cases were reconstructed with multiple flaps combining perforator(s) and local skin flaps. The reconstructions were performed using freestyle approach. Starting with propeller flap(s) in single or multilobed design and sequentially in conjunction with adjacent random pattern flaps such as fitting puzzle. All defects achieved tensionless primary closure. The final appearance resembled a jigsaw puzzle–like appearance.

Results The average size of defect was 139.6 cm2 (range, 36–345 cm2). A total of 26 perforator flaps were used in addition to 19 random pattern flaps for 18 cases. In all cases, a single perforator was used for each propeller flap. The defect and the donor site all achieved tension-free closure. The reconstruction was 100% successful without flap loss. One case of late infection was noted at 12 months after surgery.

Conclusion Using multiple lobe designed propeller flaps in conjunction with random pattern flaps in a freestyle approach, resembling putting a jigsaw puzzle together, we can achieve a tension-free closure by distributing the tension to multiple flaps, supplying sufficient volume to obliterate dead space, and have reliable vascularity as the flaps do not need to be oversized. This can be a viable approach to reconstruct extensive defects on the posterior trunk.

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