Reconstruction of Pressure Sores with Perforator-Based Propeller Flaps

ABSTRACT

Perforator flaps have been successfully used for reconstruction of pressure sores. Although V-Y advancement flaps approximate debrided wound edges, perforator-based propeller flaps allow rotation of healthy tissue into the defect. Perforator-based propeller flaps were planned in 13 patients. Seven pressure sores were over the sacrum, five over the ischial tuberosity, and one on the tip of the scapula. Three patients were paraplegic, six were bedridden, and five were ambulatory. In three patients, no perforators were found. In 10 patients, propeller flaps were transferred. In two patients, total flap necrosis occurred, which was reconstructed with local advancement flaps. In two cases, a wound dehiscence occurred and had to be revised. One hematoma required evacuation. No further complications were noted. No recurrence at the flap site occurred. Local perforator flaps allow closure of pressure sores without harvesting muscle. The propeller version has the added benefit of transferring tissue from a distant site, avoiding reapproximation of original wound edges. Twisting of the pedicle may cause torsion and venous obstruction. This can be avoided by dissecting a pedicle of at least 3 cm. Propeller flaps are a safe option for soft tissue reconstruction of pressure sores.

KEYWORDS

Propeller flaps - perforator flaps - pressure sores

REFERENCES

• 1 Hallock G G. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores.  Ann Plast Surg. 2006;  56 540-542
• 2 Coşkunfirat O K, Ozgentaş H E. Gluteal perforator flaps for coverage of pressure sores at various locations.  Plast Reconstr Surg. 2004;  113 2012-2017 discussion 2018-2019
• 3 Verpaele A M, Blondeel P N, Van Landuyt K et al.. The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores.  Br J Plast Surg. 1999;  52 385-391
• 4 Seyhan T, Ertas N M, Bahar T, Borman H. Simplified and versatile use of gluteal perforator flaps for pressure sores.  Ann Plast Surg. 2008;  60 673-678
• 5 Yildirim S, Taylan G, Aköz T. Freestyle perforator-based V-Y advancement flap for reconstruction of soft tissue defects at various anatomic regions.  Ann Plast Surg. 2007;  58 501-506
• 6 Jakubietz R G, Jakubietz M G, Jakubietz D F et al.. Ischial pressure sores: reconstruction using the perforator-based reverse flow musculocutaneous 180 degrees propeller flap.  Microsurgery. 2009;  29 672-675
• 7 Shea J D. Pressure sores: classification and management.  Clin Orthop Relat Res. 1975;  112 89-100
• 8 Nola G T, Vistnes L M. Differential response of skin and muscle in the experimental production of pressure sores.  Plast Reconstr Surg. 1980;  66 728-733
• 9 Koshima I, Moriguchi T, Soeda S, Kawata S, Ohta S, Ikeda A. The gluteal perforator-based flap for repair of sacral pressure sores.  Plast Reconstr Surg. 1993;  91 678-683
• 10 Cheon Y W, Lee M C, Kim Y S, Rah D K, Lee W J. Gluteal artery perforator flap: a viable alternative for sacral radiation ulcer and osteoradionecrosis.  J Plast Reconstr Aesthet Surg. 2010;  63 642-647
• 11 Jakubietz R G, Jakubietz M G, Gruenert J G, Kloss D F. 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;  59 667-671
• 12 Wong C H, Cui F, Tan B K et al.. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps.  Ann Plast Surg. 2007;  59 672-678
• 13 Bravo F G, Schwarze H P. Free-style local perforator flaps: concept and classification system.  J Plast Reconstr Aesthet Surg. 2009;  62 602-608 discussion 609
• 14 Blondeel P N, Beyens G, Verhaeghe R et al.. Doppler flowmetry in the planning of perforator flaps.  Br J Plast Surg. 1998;  51 202-209