Propeller Flaps in the Head and Neck
This article describes the main propeller flaps for one-stage reconstruction in the head–neck region (facial artery perforator, supratrochlear artery axial perforator, deep lingual artery axial perforator, and anterior supraclavicular artery perforator flaps), their indications, and possible complications. Aesthetic and functional results of propeller flaps in the head and neck region are very good and the complication rate is low, but due to their surgical complexity and the availability of many simpler local flaps, they are indicated only in select cases where local flaps are unavailable or would require multiple stage...
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Cordova, Adriana D'Arpa, Salvatore Rosatti, Fernando Nichelini, Marta D'Antonio, Giovanni Maria Giordano, Salvatore Toia, Francesca Tags: Review Article Source Type: research
Smartphone Thermal Imaging Can Enable the Safer Use of Propeller Flaps
Semin Plast Surg 2020; 34: 161-164 DOI: 10.1055/s-0040-1714291The use of thermography for the identification of cutaneous “hot spots” that coincide with perforators is not a new concept, but the required professional cameras may be prohibitively expensive. Only relatively recently, incredibly cheap but adequate thermal imaging cameras have become available that work in concert with the ubiquitous cell phone. This can now serve as a rapid, accurate, and complementary method for finding a perforator sufficient to serve as the hub for a perforator pedicled propeller flap. In addition, the preferred direction of rotation a...
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Hallock, Geoffrey G. Tags: Review Article Source Type: research
How to Design and Harvest a Propeller Flap
Semin Plast Surg 2020; 34: 152-160 DOI: 10.1055/s-0040-1714271Propeller flaps are local flaps based either on a subcutaneous pedicle, a single perforator, or vessels entering the flap in such a way so as to allow the flap to rotate on their axis. Depending on the kind of pedicle and the anatomical area, the preoperative investigation and the harvesting techniques may vary.An adequate knowledge of skin and subcutaneous tissue perfusion in the different areas of the body is very important to plan a propeller flap to be successful.The surgeon should begin by finding the most suitable perforators in the area surrounding the de...
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Pignatti, Marco Pinto, Valentina Docherty Skogh, Ann-Charlott Giorgini, Federico Armando Cipriani, Riccardo De Santis, Giorgio Hallock, Geoffrey G. Tags: Review Article Source Type: research
Imaging in Propeller Flap Surgery
Semin Plast Surg 2020; 34: 145-151 DOI: 10.1055/s-0040-1715159Since propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiog...
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Ono, Shimpei Ohi, Hiroyuki Ogawa, Rei Tags: Review Article Source Type: research
Our Definition of Propeller Flaps and Their Classification
Semin Plast Surg 2020; 34: 139-144 DOI: 10.1055/s-0040-1715158The term propeller flap was introduced for the first time by Hyakusoku to define an island flap, based on a subcutaneous pedicle hub, that was rotated 90 degrees to correct scar contractures due to burns. With the popularization of perforator flaps, the propeller movement was applied for the first time to a skin island vascularized only by an isolated perforator, and the terms propeller and perforator flap were used together. Thereafter, the surgical technique of propeller flaps evolved and new applications developed. With the “Tokyo consensus,” we propose...
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Pignatti, Marco Ogawa, Rei Mateev, Musa Georgescu, Alexandru V. Balakrishnan, Govindasamy Ono, Shimpei Cubison, Tania Pinto, Valentina D'Arpa, Salvatore Koshima, Isao Hyakusoku, Hiko Hallock, Geoffrey G. Tags: Review Article Source Type: research
The History of Propeller Flaps
Semin Plast Surg 2020; 34: 133-138 DOI: 10.1055/s-0040-1715157Several pedicled flaps were developed by Hyakusoku at the Nippon Medical School Hospital, Tokyo, Japan, in the 1980s to treat a large number of patients with postburn contractures. In this setting, the propeller flaps were described for the first time in 1991. The term propeller was used because of the blade shape of the skin island rotating on its axis. In 1989, Koshima introduced the term perforator flaps, whereas Hallock, in 2006, applied the perforator flap concept to the propeller flap. The name perforator pedicled propeller flap followed. Propeller flap ha...
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Hyakusoku, Hiko Ono, Shimpei Tags: Review Article Source Type: research
Introduction to “Propeller Flaps”
Semin Plast Surg 2020; 34: 131-132 DOI: 10.1055/s-0040-1715156The editors of this issue of Seminars in Plastic Surgery dedicated to propeller flaps met in 2009 at the “1st Tokyo Meeting on Perforator and Propeller Flaps.” On that occasion, as part of the advisory panel of the meeting, they contributed to the definition and classification of these flaps. Since then, several evolutions and new applications of propeller flaps appeared in the literature. In 2019, the editors met again in Bologna, Italy, where they decided to collect the experiences from prominent authors in propeller flap surgery and provide them to the re...
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Pignatti, Marco Hallock, Geoffrey G. Tags: Review Article Source Type: research
Propeller Flaps
Semin Plast Surg 2020; 34: 130-130 DOI: 10.1055/s-0040-1714085 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents | Full text (Source: Seminars in Plastic Surgery)
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Hallock, Geoffrey G. Pignatti, Marco Tags: Preface Source Type: research
Geoffrey G. Hallock, MD, and Marco Pignatti, MD
Semin Plast Surg 2020; 34: 129-129 DOI: 10.1055/s-0040-1714088 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents | Full text (Source: Seminars in Plastic Surgery)
Source: Seminars in Plastic Surgery - September 21, 2020 Category: Cosmetic Surgery Authors: Buchanan, Edward P. Tags: Introduction to the Guest Editors Source Type: research
Revision Surgery of the Cleft Palate
Seminars in Plastic Surgery 2020; 34: 120-128 DOI: 10.1055/s-0040-1709429Cleft palate repairs often require secondary surgeries and/or revisions for a variety of reasons. The most common causes are symptomatic oronasal fistulas and velopharyngeal insufficiency. Complications from primary surgery, such as wound dehiscence, infection, and hematomas, contribute to the relatively high rate of revision surgery. Prevention of postoperative complications that may lead to fistula or velopharyngeal insufficiency is key, and many techniques have been described that have reportedly decreased the incidence of secondary surgery. Manage...
Source: Seminars in Plastic Surgery - May 5, 2020 Category: Cosmetic Surgery Authors: Hu, Shirley Levinson, Jared Rousso, Joseph J. Tags: Review Article Source Type: research
Prosthetic Reconstruction of the Maxilla and Palate
Seminars in Plastic Surgery 2020; 34: 114-119 DOI: 10.1055/s-0040-1709143Maxillary defects commonly present following surgical resection of oncologic processes. The use of rotational and free flaps has largely replaced the use of prosthetic options for hard palate and maxillary reconstruction, but prostheses remain a useful tool. Prosthetic devices may be invaluable in patients considered poor candidates for surgical reconstruction secondary to poor vascularity, need for postoperative radiation, or medical comorbidities that place them at high risk for healing following reconstruction. Obturators may also be considered ove...
Source: Seminars in Plastic Surgery - May 5, 2020 Category: Cosmetic Surgery Authors: Pool, Christopher Shokri, Tom Vincent, Aurora Wang, Weitao Kadakia, Sameep Ducic, Yadranko Tags: Review Article Source Type: research
Osteoradionecrosis of the Maxilla: Conservative Management and Reconstructive Considerations
Seminars in Plastic Surgery 2020; 34: 106-113 DOI: 10.1055/s-0040-1709144The implementation of radiotherapy in the multimodal treatment of advanced head and neck cancer has greatly improved survival rates. In some patients, however, this benefit comes at the potential expense of the tissue surrounding the primary site of malignancy. Osteoradionecrosis (ORN) of the facial bones, in particular the maxilla, is a debilitating complication of radiation therapy. Exposure to ionizing radiation results in devitalization of underlying bone with necrosis of adjacent soft tissue. Controversy surrounding appropriate early intervention...
Source: Seminars in Plastic Surgery - May 5, 2020 Category: Cosmetic Surgery Authors: Shokri, Tom Wang, Weitao Vincent, Aurora Cohn, Jason E. Kadakia, Sameep Ducic, Yadranko Tags: Review Article Source Type: research
Transpalatal Approaches to the Skull Base and Reconstruction: Indications, Technique, and Associated Morbidity
This article is a PubMed literature review. A review of the literature was conducted to assess the techniques, surgical steps, and associated morbidities with transpalatal approaches to the skull base and nasopharynx. The transpalatal approach has been traditionally utilized to obtain surgical access to the nasopharynx, clivus, and craniocervical junction. Morbidity includes velopalatine insufficiency due to shortening of the soft palate from scar contraction or neuromuscular damage, thus leading to hypernasal speech and dysphagia. Middle ear effusion and oronasal or oronasopharyngeal palatal fistula are additional potenti...
Source: Seminars in Plastic Surgery - May 5, 2020 Category: Cosmetic Surgery Authors: London, Nyall R. Chan, Jimmy Y. W. Carrau, Ricardo L. Tags: Review Article Source Type: research
Premaxillary Deficiency: Techniques in Augmentation and Reconstruction
Seminars in Plastic Surgery 2020; 34: 092-098 DOI: 10.1055/s-0040-1709175Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasola...
Source: Seminars in Plastic Surgery - May 5, 2020 Category: Cosmetic Surgery Authors: Shokri, Tom Wang, Weitao Cohn, Jason E. Kadakia, Sameep Ducic, Yadranko Tags: Review Article Source Type: research
Palatomaxillary Reconstruction: Fibula or Scapula
Seminars in Plastic Surgery 2020; 34: 086-091 DOI: 10.1055/s-0040-1709431Palatomaxillary reconstruction presents a unique challenge for the reconstructive surgeon. The maxillofacial skeleton preserves critical aerodigestive functions—it provides a stable hard palate to support mastication and separate the nasal and oral cavities, and buttress support to provide adequate midface contour. Free tissue transfer has become a routine part of the reconstructive ladder in managing palatomaxillary defects. While there is a wide variety of options for bony reconstruction within the head and neck, the fibula and the scapula, and th...
Source: Seminars in Plastic Surgery - May 5, 2020 Category: Cosmetic Surgery Authors: Badhey, Arvind K. Khan, Mohemmed N. Tags: Review Article Source Type: research
