Islanded Pedicled Perforator Flaps for Various Soft Tissue Defects: Our Experience in a Tertiary Hospital

Introduction: Soft tissue defects requiring flap coverage are resurfaced by peninsular flaps, musculocutaneous flaps or distant free flaps. Islanding flaps in a single stage avoids unaesthetic standing cutaneous deformity and bulges of local peninsular flaps and reduces the prolonged duration of hospital stay over certain staged procedures like cross-leg flaps. Aims and objectives: This prospective interventional study over one year aimed at executing islanded, pedicled perforator flaps and to assess the operative time for reconstruction, the complications and the post-operative hospital stay. Methodology: Patients were selected based on the defects to be reconstructed, the pre operative work up and anesthesia check up were done, they were admitted and operated. Planning in reverse was done in every case, the source vessels and the perforators were identified and marked with hand held Doppler pre-operatively, the primary defect defined after excision and the flaps were harvested based on the perforator, inset given and donor sites managed. Post-operatively the flaps were monitored clinically, the complications and issues addressed, dressings changed on frequent intervals and results interpreted. After discharge, they were followed up at regular intervals. Results: Out of 35 patients, in 15 patients, the flaps were harvested on perforators as propeller flaps. In 20 patients we dissected up to and included the source vessel of the perforators to gain additional length. The mean operative time for reconstruction was 105 minutes. Among the overall complications of 14%, minor complications of wound dehiscence and widened scar in 3% of the cases. The post-operative hospital stay ranged from 3 to 14 days with a mean of 4.75 days. Conclusion: Islanded perforator flaps can be executed rapidly increasing the daily number of reconstructions in a high volume centre with reduced hospital stay, less donor site morbidities and more aesthetically pleasing results. Key words: Propeller flaps, perforator flaps. Conflict of interest- none.