Abstract
Background It is a common experience for reconstructive surgeons to feel the necessity for large
flaps and minimal donor-site morbidity at the same time. In the reported cases where
we felt this call intraoperatively, we have met our need by applying the “propeller
concept” to fasciocutaneous or composite flaps, separating and rotating its different
tissue components.
Methods We present a series of five cases in which we separated and rotated diversely fascial
and cutaneous components of free perforator flaps to enhance the extension of the
flap or to tailor it better on the tissue gap for optimal functional and aesthetic
results. We also propose a simple nomenclature system for rotation angles' definition,
summarized as the “clock flap” classification, where the different components of the
flap represent the arms of a clock which has the main vessel axis on the 12–6 line.
Results All reconstructive procedures succeeded with only minor complications. No partial
failure due to vessel rotations was noticed.
Conclusion Applying “propeller style” rotations to different components of free flaps seems
to be a safe procedure which may help maximize flap performance in terms of coverage
of the recipient site, while minimizing scars and impairment of the donor site. Also,
the proposed nomenclature gives the opportunity to record and compare surgical procedures
for statistical analysis.
Keywords
free flap - propeller - clock flap
