The Preoperative Planning, Design, and Execution of the Freestyle Propeller Flap: A Detailed Description and the Case Series
Case series published in Arch Plast Surg (2025)
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Retrospective series of 20 propeller-flap reconstructions with two cases of venous congestion (10%) resolved by leech therapy without necrosis. Documents preoperative planning and surgical technique guidelines.
Why This Matters for Hirudotherapy
This article reports a case series of 20 consecutive patients undergoing propeller flap reconstruction between January 2018 and December 2020, detailing preoperative planning with CT angiography and color Doppler ultrasound, surgical techniques, and outcomes including no total flap loss, one partial flap loss (5%), and two cases of venous congestion (10%) that resolved following leech therapy without necrosis. For ASH's domain, this demonstrates hirudotherapy as a practical salvage measure for venous congestion in flap surgery with successful outcomes in the reported cases. The abstract provides no detail on leech species, protocol, duration, or complications specifically attributable to leech therapy. The leech therapy mention is incidental to the primary focus on surgical planning and execution, and the sample size for leech-treated cases is only two patients.
Citation
The Preoperative Planning, Design, and Execution of the Freestyle Propeller Flap: A Detailed Description and the Case Series.
Kim HB et al. · Archives of plastic surgery, 2025
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