An useful technical trick to reduce the pedicle twisting in propeller flaps: the polar safety stitch (PSS)

The rotation of the flap pedicle is usually discouraged in reconstructive surgery because it could affect the patency of both the pedicle artery and vein. Propeller flaps usually require pedicle rotations of 180°, raising the risk of venous and arterial occlusion. We present a technical trick which consists of a serial rotation of the perforator flap, reducing the rotation angle of the pedicle, thus reducing also the effective strain and stress. We applied this technique on seven propeller flaps in seven patients, from July 2010 to April 2012. The patients healed without relevant complications and further surgical procedures. Neither partial nor complete necrosis of the flap was observed. In one case, suture dehiscence along with partial graft take at the flap donor site occurred; in another case, a mild venous congestion was observed and healed uneventfully in 2 days. Our technique in positioning propeller flaps is able to reduce the twisting of the pedicle, issue which affects the patency of both pedicle artery and vein. This trick reduces the odds of flap ischemia. In our case series, flap necrosis, both partial and complete, was not observed. This technical trick is able to make propeller flaps more reliable and extensively applicable, especially in lower limbs and extensive trauma, where tissue elasticity is reduced leaving unaltered the reconstructive potential of propeller flaps.

Level of Evidence: Level V, therapeutic study.