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CC BY-NC-ND 4.0 · Indian J Plast Surg 2019; 52(03): 330-336
DOI: 10.1055/s-0039-3400354
Original Article
Association of Plastic Surgeons of India

Saphenous Artery Perforator/Propeller Flap in the Reconstruction of Perigenual Soft Tissue Defects

T. M. Balakrishnan 
1   Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Aishwarya Vadakencherry Lakshmi Narayanan
1   Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
,
J. Jaganmohan
1   Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
› Author Affiliations
Further Information

Publication History

received 08 May 2019

accepted after revision 04 October 2019

Publication Date:
23 December 2019 (online)

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Abstract

Introduction In this article, we investigate the saphenous artery perforator propeller flap for the reconstruction of perigenual defects. We describe the anatomy of the saphenous artery and the method of raising a perforator propeller flap based on our study and early clinical experience.

Aim To assess the effectiveness of the saphenous artery perforator propeller flap in the reconstruction of perigenual defects.

Materials and Methods A preliminary cadaver dissection and injection study was conducted to discern the anatomical details of the perforator system of the saphenous vessel in 35 cadaveric specimens in 18 fresh cadavers. From March 2016 to March 2018, 16 clinical cases (5 females and 11 males, in the average age group of 33.5 years) with perigenual defects were reconstructed with saphenous artery perforator propeller flap. They were followed up for an average period of 12.5 months.

Results Cadaver study established anterior sartorial perforators as the dominant system of the saphenous vessel and brought to the forefront the type 2 blood supply of the saphenous nerve. All patients had well-settled flaps at the end of the follow-up period, with good return of knee function.

Conclusion Saphenous artery perforator propeller flap is a viable option for the reconstruction of defects around the knee joint.

Level of Evidence Type V, therapeutic study.

Keywords

perigenual soft tissue defects - saphenous artery perforator propeller flap - saphenous vessel - soft tissue defects of the knee
 

  • References

  • 1 Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg 2004; 114 (04) 910-916
    CrossrefPubMedSearch in Google Scholar
  • 2 Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg 2003; 30 (03) 473-480
    CrossrefPubMedSearch in Google Scholar
  • 3 Wallace CG, Kao HK, Jeng SF, Wei FC. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg 2009; 124 (Suppl. 06) e419-e426
    CrossrefPubMedSearch in Google Scholar
  • 4 Eom JS, Hong JP. Lower back defect coverage using a free-style gluteal perforator flap. Ann Plast Surg 2011; 67 (05) 516-519
    CrossrefPubMedSearch in Google Scholar
  • 5 Eom JS, Sun SH, Hong JP. Use of the upper medial thigh perforator flap (gracilis perforator flap) for lower extremity reconstruction. Plast Reconstr Surg 2011; 127 (02) 731-737
    CrossrefPubMedSearch in Google Scholar
  • 6 Acland RD, Schusterman M, Godina M, Eder E, Taylor GI, Carlisle I. The saphenous neurovascular free flap. Plast Reconstr Surg 1981; 67: 763-774
    CrossrefPubMedSearch in Google Scholar
  • 7 Koshima I, Endou T, Soeda S, Yamasaki M. The free or pedicled saphenous flap. Ann Plast Surg 1988; 21 (04) 369-374
    CrossrefPubMedSearch in Google Scholar
  • 8 Karamürsel S, Celebioğlu S. Use of the medial side of the knee skin as a free flap: saphenous flap. Plast Reconstr Surg 2006; 117 (04) 1308-1314
    CrossrefPubMedSearch in Google Scholar
  • 9 Kansal S, Goil P, Agarwal V. et al. Reverse pedicle-based greater saphenous neuro-veno-fasciocutaneous flap for reconstruction of lower leg and foot. Eur J Orthop Surg Traumatol 2014; 24 (01) 67-72
    CrossrefPubMedSearch in Google Scholar
  • 10 Bertelli JA. The saphenous postero-medial cutaneous island thigh flap and the saphenous supero-medial cutaneous island leg flap (25.91). Surg Radiol Anat 1992; 14 (02) 187-189
    CrossrefPubMedSearch in Google Scholar
  • 11 Torii S, Hayashi Y, Hasegawa M, Sugiura S. Reverse flow saphenous island flap in the patient with below-knee amputation. Br J Plast Surg 1989; 42 (05) 517-520
    CrossrefPubMedSearch in Google Scholar
  • 12 Breidenbach WC, Terzis JK. The blood supply of vascularized nerve grafts. J Reconstr Microsurg 1986; 3 (01) 43-58
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Gocmen-Mas N, Aksu F, Edizer M, Magden O, Tayfur V, Seyhan T. The arterial anatomy of the saphenous flap: a cadaveric study. Folia Morphol (Warsz) 2012; 71 (01) 10-14
    Search in Google Scholar
  • 14 Li Z, Ding Z, Wang P, Xie Y, Zeng B. Li Z1. [Applied anatomy study and clinical application of great saphenous veno-saphenous neurocutaneous vascular flap]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2006; 20 (03) 259-263
    PubMedSearch in Google Scholar
  • 15 Sananpanich K, Atthakomol P, Luevitoonvechkij S, Kraisarin J. Anatomical variations of the saphenous and descending genicular artery perforators: cadaveric study and clinical implications for vascular flaps. Plast Reconstr Surg 2013; 131 (03) 363e-372e
    CrossrefPubMedSearch in Google Scholar
  • 16 Cormack GC, Lamberty GH. The Arterial Anatomy of Skin Flaps. 2nd ed. New York, NY: Churchill Livingstone; 1994: 428-430
    Search in Google Scholar
  • 17 Kimura N, Satoh K, Hosaka Y. Microdissected thin perforator flaps: 46 cases. Plast Reconstr Surg 2003; 112 (07) 1875-1885
    CrossrefPubMedSearch in Google Scholar
  • 18 Behan F, Sizeland A, Porcedu S, Somia N, Wilson J. Keystone island flap: an alternative reconstructive option to free flaps in irradiated tissue. ANZ J Surg 2006; 76 (05) 407-413
    CrossrefPubMedSearch in Google Scholar
  • 19 Rubino C, Ramakrishnan V, Figus A, Bulla A, Coscia V, Cavazzuti MA. Flap size/flow rate relationship in perforator flaps and its importance in DIEAP flap drainage. J Plast Reconstr Aesthet Surg 2009; 62 (12) 1666-1670
    CrossrefPubMedSearch in Google Scholar
  • 20 Balakrishnan TM, Ramkumar J, Jaganmohan J. Ad hoc posterior tibial vessels perforator propeller flaps for the reconstruction of lower third leg soft-tissue defects. Indian J Plast Surg 2017; 50 (03) 281-287
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Vasconez LO, Bostwick III J. McCraw J. Coverage of exposed bone by muscle transposition and skin grafting. Plast Reconstr Surg 1974; 53 (05) 526-530
    CrossrefPubMedSearch in Google Scholar
  • 22 McCraw JB. Selection of alternative local flaps in the leg and foot. Clin Plast Surg 1979; 6 (02) 227-246
    CrossrefPubMedSearch in Google Scholar
  • 23 Mathes SJ, Nahai F. Clinical Applications for Muscle and Musculocutaneous Flaps. St Louis, MO: CV Mosby; 1982
    Search in Google Scholar
  • 24 Meller I, Ariche A, Sagi A. The role of the gastrocnemius muscle flap in limb-sparing surgery for bone sarcomas of the distal femur: a proposed classification of muscle transfers. Plast Reconstr Surg 1997; 99 (03) 751-756
    CrossrefPubMedSearch in Google Scholar
  • 25 Arnold PG, Mixter RC. Making the most of the gastrocnemius muscles. Plast Reconstr Surg 1983; 72 (01) 38-48
    CrossrefPubMedSearch in Google Scholar
  • 26 Tetreault MW, Della Valle CJ, Hellman MD, Wysocki RW. Medial gastrocnemius flap in the course of treatment for an infection at the site of a total knee arthroplasty. JBJS Essential Surg Tech 2017; 7 (02) e14
    Search in Google Scholar
  • 27 Misra A, Niranjan NS. Fasciocutaneous flaps based on fascial feeder and perforator vessels for defects in the patellar and peripatellar regions. Plast Reconstr Surg 2005; 115 (06) 1625-1632
    CrossrefPubMedSearch in Google Scholar
  • 28 Akhtar MS, Khan AH, Khurram MF, Ahmad I. Inferiorly based thigh flap for reconstruction of defects around the knee joint. Indian J Plast Surg 2014; 47 (02) 221-226
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Blondeel PN, Morris SF, Hallock GG, Neligan PC. Perforator Flaps: Anatomy, Technique, & Clinical Applications. 2nd ed. St. Louis, MO: Quality Medical Publishing 2013
  • 30 Winkel R, Tajsic N, Husum H, Schlageter M, Hanebuth G, Hoffmann R. Saphenous perforator flap [in German]. Oper Orthop Traumatol 2013; 25 (02) 152-161
    CrossrefPubMedSearch in Google Scholar