Extensive Defect Reconstruction Using Multiple Perforator Propeller Flaps in a Jigsaw Puzzle Approach.

Abstract

Reconstruction of extensive defects remains a challenge. The authors report their experience with extensive defect reconstruction using multiple perforator propeller flaps and provide a systematic review of the literature on this approach. This retrospective study included patients who underwent defect reconstruction with multiple perforator propeller flaps from 2014 to 2021. A systematic review was conducted by retrieving studies on reconstructive strategy from PubMed, Web of Science, Embase, and Scopus published before December 1, 2022. Thirty patients underwent defect reconstruction using 65 perforator propeller flaps. The posterior trunk (66.7%) was the most common site of defects. Complete flap survival was achieved in 61 flaps (93.8%). Partial necrosis of 4 flaps in 3 patients and venous congestion of 1 flap resulted in an overall complication rate of 13.3%. One flap experienced distal tip necrosis in 21 patients undergoing posterior trunk or perineal defect reconstruction, leading to an overall complication rate of 4.7%. Other complications were observed during the reconstruction of defects in the lower extremities (1 of 5 patients) and anterior trunk (2 of 4 patients). In the systematic review, 11 articles involving 74 patients were identified. Commonly reported locations of the defects were the perineum (55.4%) and posterior trunk (33.8%). Flap-related complications included venous congestion; no flaps were lost. This study on the use of multiple perforator propeller flaps in a jigsaw puzzle approach demonstrated that the method can be used effectively for extensive posterior trunk and perineal defect reconstruction. Risk, III.