Propeller perforator flaps in forearm and hand reconstruction

  • Alexandru Valentin Georgescu
  • Ileana Rodica MateiEmail author
Original Article • HAND - MICROSURGERY


After a long history in flaps’ surgery, the perforator flaps became the most used flaps nowadays. From the beginning, their use as free flaps diminished substantially the donor site morbidity. In the attempt to not only diminish the donor site morbidity, but also to achieve more similar reconstructions, a new concept appeared 20 years ago: local perforator flaps. The local perforator flaps offer as main advantages the absence of microsurgical sutures (“microsurgical non-microvascular flaps”), same surgical field, the sparing of muscles and main vascular pedicles, and shorter hospitalization time. They can be used as V–Y advancement flaps, transposition flaps, propeller flaps, and keystone flaps (multiperforator flaps). The present study will refer to the use of local perforator flaps in forearm and hand reconstruction, and will point on the most important technical aspects of their harvesting, the main indications, advantages and disadvantages, and possible complications.


Forearm defects Hand defects Perforator flaps Propeller perforator flaps 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study


  1. 1.
    Acar MA, Güleç A, Aydin BK, Erkoçak ÖF, Elmadag M, Türkmen F (2015) Reconstruction of dorsal hand and finger defects with reverse radial fasciocutaneous forearm flaps. Eur J Orthop Surg Traumatol 25(4):723–729. CrossRefGoogle Scholar
  2. 2.
    Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40:113–141CrossRefGoogle Scholar
  3. 3.
    Manchot C (1983) The cutaneous arteries of the human body. Springer, New YorkCrossRefGoogle Scholar
  4. 4.
    Salmon M. In: Taylor GI, Tempest M, (eds) (1988) Arteries of the skin. London: Churchill LivingstoneGoogle Scholar
  5. 5.
    Saint-Cyr M, Wong C, Schaverien M et al (2009) Perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 124:1529–1544CrossRefGoogle Scholar
  6. 6.
    Rubino C, Coscia V, Cavazzuti AM et al (2006) Haemodynamic enhancement in perforator flaps: the inversion phenomenon and its clinical significance: a study of the relation of blood velocity and flow between pedicle and perforator vessels in perforator flaps. J Plast Reconstr Aesthet Surg 59:636–643CrossRefGoogle Scholar
  7. 7.
    Kroll SS, Rosenfield L (1988) Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 81:561–566CrossRefGoogle Scholar
  8. 8.
    Koshima I, Soeda S (1989) Inferior epigastric artery skin flap without rectus abdominis muscle. Br J Plast Surg 42:645–648CrossRefGoogle Scholar
  9. 9.
    Lecours C, Saint-Cyr M, Wong C et al (2010) Freestyle pedicle perforator flaps: clinical results and vascular anatomy. Plast Reconstr Surg 126:1589–1603CrossRefGoogle Scholar
  10. 10.
    Georgescu AV, Matei I, Ardelean F et al (2007) Microsurgical nonmicrovascular flaps in forearm and hand reconstruction. Microsurgery 27:384–394CrossRefGoogle Scholar
  11. 11.
    Matei I, Georgescu AV, Chiroiu B et al (2008) Harvesting of forearm perforator flaps based on intraoperative vascular exploration: clinical experiences and literature review. Microsurgery 28:321–330CrossRefGoogle Scholar
  12. 12.
    Lee BT, Lin SJ, Bar-Meir ED et al (2010) Pedicled perforator flaps: a new principle in reconstructive surgery. Plast Reconstr Surg 125:201–208CrossRefGoogle Scholar
  13. 13.
    AlV Georgescu (2012) Propeller perforator flaps in distal lower leg: evolution and clinical applications. Arch Plast Surg 39(2):94–105CrossRefGoogle Scholar
  14. 14.
    van Waes OJ, Halm JA, Vermeulen J, Ashford BG (2013) The Practical Perforator Flap: the sural artery flap for lower extremity soft tissue reconstruction in wounds of war. Eur J Orthop Surg Traumatol 23(Suppl 2):S285–S289. CrossRefGoogle Scholar
  15. 15.
    Chang YT, Wang XF, Zhou ZF et al (1988) The reversed forearm fasciocutaneous flap in hand reconstruction: 10 successful cases. Chin J Plast Surg Burns 4:41–49Google Scholar
  16. 16.
    Hyakusoku H, Yamamoto T, Fumiiri M (1991) The propeller flap method. Br J Plast Surg 44:53–54CrossRefGoogle Scholar
  17. 17.
    Hallock GG (2006) The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg 56:540–542CrossRefGoogle Scholar
  18. 18.
    Pignatti M, Ogawa R, Hallock GG et al (2011) The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg 127:716–722CrossRefGoogle Scholar
  19. 19.
    McCraw JB, Myers B, Shanklin KD (1977) The value of fluorescein in predicting the viability of arterialized flaps. Plast Reconstr Surg 60:710–719CrossRefGoogle Scholar
  20. 20.
    Morykwas MJ, Hills H, Argenta LC (1991) The safety of intravenous fluorescein administration. Ann Plast Surg 26:551–553CrossRefGoogle Scholar
  21. 21.
    Eren S, Rubben A, Krein R et al (1995) Assessment of microcirculation of an axial skin flap using indocyanine green fluorescence angiography. Plast Reconstr Surg 96:1636–1649CrossRefGoogle Scholar
  22. 22.
    Holm C, Mayr M, Hofter E et al (2002) Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55:635–644CrossRefGoogle Scholar
  23. 23.
    Matsui A, Lee BT, Winer JH et al (2009) Real-time intraoperative near-infrared fluorescence angiography for perforator identification and flap design. Plast Reconstr Surg 123:125e–127eCrossRefGoogle Scholar
  24. 24.
    Kanellakos GW, Yang D, Morris SF (2003) Cutaneous vasculature of the forearm. Ann Plast Surg 50:387–392CrossRefGoogle Scholar
  25. 25.
    Maruyama Y (1990) The reverse dorsal metacarpal flap. Br J Plast Surg 43:24–27CrossRefGoogle Scholar
  26. 26.
    Quaba AA, Davison PM (1990) The distally-based dorsal hand flap. Br J Plast Surg 43:28–39CrossRefGoogle Scholar
  27. 27.
    Koshima I, Urushibara K, Fukuda N et al (2006) Digital artery perforator flaps for fingertip reconstructions. Plast Reconstr Surg 118:1579–1584CrossRefGoogle Scholar
  28. 28.
    Cormack GC, Lamberty BG (1984) Fasciocutaneous vessels: their distribution on the trunk and limbs, and their clinical application in tissue transfer. Anat Clin 6:121–131CrossRefGoogle Scholar
  29. 29.
    Saint-Cyr M, Mujadzic M, Wong C et al (2010) The radial artery pedicle perforator flap: vascular analysis and clinical implications. Plast Reconstr Surg 125:1469–1478CrossRefGoogle Scholar
  30. 30.
    Koshima I, Moriguchi T, Etoh H et al (1995) The radial artery perforator based adipofascial flap for dorsal hand coverage. Ann Plast Surg 35:474–479CrossRefGoogle Scholar
  31. 31.
    Yu P, Chang EI, Selber JC, Hanasono MM (2012) Perforator patterns of the ulnar artery perforator flap. Plast Reconstr Surg 129:213–220CrossRefGoogle Scholar
  32. 32.
    Mathy JA, Moaveni Z, Tan ST (2013) Vascular anatomy of the ulnar artery perforator flap. Plast Reconstr Surg 131:115e–116eCrossRefGoogle Scholar
  33. 33.
    Angrigiani C, Grilli D, Dominikow D et al (1993) Posterior interosseous reverse forearm flap: experience with 80 consecutive cases. Plast Reconstr Surg 92:285–293CrossRefGoogle Scholar
  34. 34.
    Hubmer MG, Fasching T, Haas F et al (2004) The posterior interosseous artery in the distal part of the forearm. Is the term “recurrent branch of the anterior interosseous artery” justified? Br J Plast Surg 57:638–644CrossRefGoogle Scholar
  35. 35.
    Mei J, Morris SF, Ji W et al (2013) An anatomic study of the dorsal forearm perforator flaps. Surg Radiol Anat 35:695–700CrossRefGoogle Scholar
  36. 36.
    Landi A, Luchetti R, Soragni O et al (1991) The distally based interosseous island flap for the coverage of skin loss of the hand. Ann Plast Surg 27:527–536CrossRefGoogle Scholar
  37. 37.
    Syed SA, Zahir KS, Zink JR et al (1997) Distal dorsal forearm flap. Ann Plast Surg 38:396–403CrossRefGoogle Scholar
  38. 38.
    Yousif NJ, Ye Z, Grunert BK et al (1998) Analysis of the distribution of cutaneous perforators in cutaneous flaps. Plast Rconstr Surg 101:72–84CrossRefGoogle Scholar
  39. 39.
    Schaverien M, Saint-Cyr M (2008) Suprafascial compared with subfascial harvest of the radial forearm flap: an anatomic study. J Hand Surg (Am) 33:97–101CrossRefGoogle Scholar
  40. 40.
    Bailey SH, Andry D, Saint-Cyr M (2010) The dorsal metacarpal artery perforator flap: a case report utilizing a quaba flap harvested from a previously skin-grafted area for dorsal 5th digit coverage. Hand (N Y) 5(3):322–325CrossRefGoogle Scholar
  41. 41.
    Omokawa S, Tanaka Y, Ryu J et al (2005) The anatomical basis for reverse first to fifth dorsal metacarpal arterial flaps. J Hand Surg (Br) 30:40–44CrossRefGoogle Scholar
  42. 42.
    Bakhach L, Demiri E, Conde A et al (1999) Le lambeau metacarpien dorsal a pedicule retrograde etendu. Etude anatomique et a propos de 22 cas cliniques. Ann Chir Plast Esthet 44:185–193Google Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinical Hospital of Rehabilitation Cluj NapocaUniversity of Medicine Iuliu Hatieganu Cluj NapocaCluj NapocaRomania

Personalised recommendations