Clinical application of perforator propeller flaps with anastomosis of superficial veins

Objective To investigate the clinical effect of anastomosis of superficial veins for improving the drainage of perforator propeller flaps. Methods From Sept. 2011 to Dec. 2012, 11 cases with soft tissue defects and chronic ulcer wound at extremities were treated with adjacent perforator propeller flaps, which were pedicled by the peroneal artery(5 cases), or the lateral supramalleolar artery(3 cases), or the ulnar artery(2 cases), or the posterior interrosseous artery(1 case). The wound size ranged from from 3.0 cm×2.5 cm to 11.0 cm×4.0 cm, and the falps size ranged from 6 cm×3 cm to 21 cm×5 cm.One superficial vein in all the flaps was anastomosed with superficial vein in the recipient area. The blood supply of the flaps were recorded after operation 1-3 months after operation, the fluency of anastomosed vein was detected by color Doppler ultrasound. Flap swelling evaluations were performed in early 3 months and later 3-6 months, and the results were classified into 4 grading degrees. 6 months later, Questionnaire of the flap aesthetic satisfactory was performed for seven patients during follow-up period. Results 9 flaps survived completely, two flaps had partial marginal skin necrosis in the distal end, which were both managed with surgical debridement, and both wounds healed in two months. 9 cases were followed up for more than 12-19 months. The early rsults of flap swelling evaluations were: Ⅰdegree 0 case, Ⅱdegree 8 cases, Ⅲ degree 3 cases, Ⅳ degree 0 case, and the later results were: Ⅰdegree 7 cases, Ⅱdegree 4 cases, Ⅲ degree 0 case, Ⅳ degree 0 case.The flaps had ideal appearance, good contour, and high aesthetic satisfactory(100%). The mean flap survival area rate of veins anastomosed was (98.6±9.7)%. Conclusions Perforator propeller flaps with anastomosis of superficial veins can improve the flap venous drainage, avoid transient venous venous congestion, so as to increase the flap survival. It is an effective way for improving the vein drainage. Key words: Surgical flaps; Perforator flap; Microsurgical operation; Vein