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Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction

BACKGROUND: In distal lower limb defects, the paucity of local tissues dictates a free-flap (FF)-based reconstruction frequently. The propeller perforator flap (PPF) offers a good alternative when the patient or the limb or both are not fit for FF-based reconstruction. Also, in contexts of restricte...

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Autores principales: Eldahshoury, Tarek, Cacciola, Roberto, El-Gazzar, Khaled
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683242/
https://www.ncbi.nlm.nih.gov/pubmed/34934603
http://dx.doi.org/10.1097/GOX.0000000000003993
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author Eldahshoury, Tarek
Cacciola, Roberto
El-Gazzar, Khaled
author_facet Eldahshoury, Tarek
Cacciola, Roberto
El-Gazzar, Khaled
author_sort Eldahshoury, Tarek
collection PubMed
description BACKGROUND: In distal lower limb defects, the paucity of local tissues dictates a free-flap (FF)-based reconstruction frequently. The propeller perforator flap (PPF) offers a good alternative when the patient or the limb or both are not fit for FF-based reconstruction. Also, in contexts of restricted healthcare resources, armed conflict scenarios, or during pandemics like the ongoing COVID-19 pandemic, PPF is considered a valuable alternative to free-flap-based reconstruction. Additionally, PPFs are less sacrificing in terms of major limb vessels and distal limb vascularity. Yet, the distal lower limb vascular impact for PPF-based reconstruction has not been studied before. METHODS: In total, 23 patients with distal lower limb defects were reconstructed with PPFs. By using U/S arterial duplex, the peak arterial velocity (PA velocity) was measured pre and postoperatively in 15 (65.2%) out of the 23 patients. This measurement was done to the vessel segment distal to the used perforator. RESULTS: An estimated 21 out of 23 flaps succeeded to reconstruct the patients’ defects safely and to give all patients stable coverage without further surgeries. Only two patients had flap failure, which was managed successfully through additional reconstruction sessions. The difference between pre- and postoperative PA velocity was not statistically significant. CONCLUSIONS: PPFs are a safe cost-effective reconstruction modality for distal lower limb defects. This advantage is very valuable in cases of restricted healthcare resources, wars, and during pandemics. In terms of distal limb vascularity, PPFs have no significant impact and can be used safely.
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spelling pubmed-86832422021-12-20 Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction Eldahshoury, Tarek Cacciola, Roberto El-Gazzar, Khaled Plast Reconstr Surg Glob Open Reconstructive BACKGROUND: In distal lower limb defects, the paucity of local tissues dictates a free-flap (FF)-based reconstruction frequently. The propeller perforator flap (PPF) offers a good alternative when the patient or the limb or both are not fit for FF-based reconstruction. Also, in contexts of restricted healthcare resources, armed conflict scenarios, or during pandemics like the ongoing COVID-19 pandemic, PPF is considered a valuable alternative to free-flap-based reconstruction. Additionally, PPFs are less sacrificing in terms of major limb vessels and distal limb vascularity. Yet, the distal lower limb vascular impact for PPF-based reconstruction has not been studied before. METHODS: In total, 23 patients with distal lower limb defects were reconstructed with PPFs. By using U/S arterial duplex, the peak arterial velocity (PA velocity) was measured pre and postoperatively in 15 (65.2%) out of the 23 patients. This measurement was done to the vessel segment distal to the used perforator. RESULTS: An estimated 21 out of 23 flaps succeeded to reconstruct the patients’ defects safely and to give all patients stable coverage without further surgeries. Only two patients had flap failure, which was managed successfully through additional reconstruction sessions. The difference between pre- and postoperative PA velocity was not statistically significant. CONCLUSIONS: PPFs are a safe cost-effective reconstruction modality for distal lower limb defects. This advantage is very valuable in cases of restricted healthcare resources, wars, and during pandemics. In terms of distal limb vascularity, PPFs have no significant impact and can be used safely. Lippincott Williams & Wilkins 2021-12-17 /pmc/articles/PMC8683242/ /pubmed/34934603 http://dx.doi.org/10.1097/GOX.0000000000003993 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Reconstructive
Eldahshoury, Tarek
Cacciola, Roberto
El-Gazzar, Khaled
Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction
title Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction
title_full Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction
title_fullStr Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction
title_full_unstemmed Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction
title_short Safety and Vascular Impact of Perforator Propeller Flaps during Distal Lower Limb Reconstruction
title_sort safety and vascular impact of perforator propeller flaps during distal lower limb reconstruction
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683242/
https://www.ncbi.nlm.nih.gov/pubmed/34934603
http://dx.doi.org/10.1097/GOX.0000000000003993
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