Propeller Flaps: A Review of Indications, Technique, and Results
Figure 1
(a) Left Achilles tendon exposure after open repair. (b) The flap has been drawn around the perforator with the best sound. A wide exploratory incision is performed to visualize it. (c) Optimal perforator visualization, such as that shown in the picture, must be possible through the exploratory incision. When exposure is inadequate, the incision should be lengthened. In this case the proximal perforator was directed to the skin and the distal to the soleus muscle; plan B option for this case. (d) The flap has been islanded and left on the perforator alone to let the circulation settle. A superficial vein (greater saphenous vein in this case) should be preserved for venous supercharging whenever possible. A strip of soleus tendon is harvested for Achilles tendon reconstruction as described by Cavadas and Landin [10]. (e) The most convenient sense of rotation is chosen. While the flap’s circulation settles before rotation, donor site closure can be accomplished. (f) After rotation, the pedicle is always double checked for torsions, traction, or kinking that must be, if present, immediately eliminated. (g) Closure must be obtained without any tension. Note that the flap is a little longer than required to compensate postoperative swelling. (h) Six months postoperative result shows complete flap survival.
