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Reconstruction of Anterolateral Thigh Defects Using Perforator-Based Propeller Flaps

Iida, Takuya MD; Yoshimatsu, Hidehiko MD; Koshima, Isao MD

doi: 10.1097/SAP.0000000000001175
Reconstructive Surgery

Background Usually, anterolateral thigh (ALT) defects with width more than 8 cm cannot be closed directly. Although several methods of using local flaps exist, flap mobility of these methods is limited. We introduced a perforator-based propeller flap for such reconstruction. Their maximal mobility, which minimizes their size, is their greatest advantage. In addition, we present our technical refinements including double-axes propeller flap, the use of indocyanine green real-time angiography, and supercharged propeller flap for safer flap transfer.

Patients and Methods Seven patients underwent perforator-based propeller flap reconstruction of ALT defects. Flaps were designed cranial or caudal to the defect according to the perforator locations. To maximize mobility, flaps were designed so that the perforator was located at the periphery and closer to the defect. After rotating the flap to the defect, indocyanine green angiography was performed to determine the need for supercharge.

Results In all cases, all flaps survived completely. Defect size ranged from 12 × 11 cm to 18 × 16 cm, and flap size ranged from 7 × 5 cm to 15 × 7 cm. The number of perforators in the flap was 1 in 3 cases and 2 in 4 cases. Supercharging was performed in 3 cases. Donor-site complications, including gait disturbance, were not observed.

Conclusions This method achieves ALT defect closure with minimal donor-site morbidity and can provide prompt and aesthetically acceptable results. Indocyanine green real-time angiography and supercharging technique are also useful for safer and reliable flap transfer.

From the Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.

Received January 4, 2017, and accepted for publication, after revision May 16, 2017.

Conflicts of interest and sources of funding: none declared.

Reprints: Takuya Iida, MD, Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1138655, Japan. E-mail:

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