Plastic Surgery Research Council
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Presenter: Lorenz Larcher, MD1,2
Co-Author: Georg M. Huemer, MD, MSc, MBA2
1Hospital St. John of God (Barmherzige Brüder) Salzburg, Salzburg, Austria
2Section of Plastic and Reconstructive Surgery, General Hospital Linz, Linz, Austria

Acknowledgment: This presentation was presented in August 2012 at the EPSRC (Hamburg / Germany) and was awarded as best oral presentation of the meeting.

Background: A perforator flap that is intended as a free flap can be harvested as a pedicled flap instead. Applying perforator flap concepts in local reconstruction can yield excellent results. This relatively new approach further expands the armamentarium of the reconstructive surgeon.

Patients and Methods: The authors present their personal experience with local reconstruction in several anatomical regions with pedicled propeller perforator flaps arising from various source vessels. A backup plan was made preoperative with the patients in case no adequate perforator vessels were found.

Results: Between July 2006 and May 2012, 30 pedicled perforator propeller flaps were performed for reconstruction in various anatomical regions at General Hospital Linz, Austria. 15 different source vessels were used. The indications for defect reconstruction spanned from oncological resections, decubitus ulcers, posttraumatic defect to meningomyelocele. We suffered from one complete flap loss and in 4 cases partial tip necrosis of the flap occurred, which was managed by means of debridement and conservative wound management.

Conclusion: The principles of perforator dissection and flap design can be applied to pedicled flaps for local and regional reconstruction. These axially-based flaps can be used in virtually every anatomical locations as seen in our case series. Proper understanding of perforator anatomy increases reliability and allows greater freedom of flap design. The biggest advantage for this kind of reconstruction is the symbiosis between diminished donor site morbidity and an aesthetic superior reconstruction replacing "like with like". Elimination of the microsurgical component is an additional advantage making these flaps more widely applicable with a decreased risk of flap loss. However, drawbacks include the variability of vascular anatomy in the region of the defect as well as previous interventions or trauma resulting in scars which can sometimes render a local reconstruction impossible.

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