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Useful Flaps for Plastic Surgeons to Know | Journa ...
Journal CME Article: Useful Flaps for Plastic Surg ...
Journal CME Article: Useful Flaps for Plastic Surgeons to Know (Video 4)
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Video Transcription
An exploratory incision is always made to inspect the perforator before designing a propeller flap. In this case, a propeller flap is being elevated based on the posterior tibial system to cover a defect in the lower leg. Here the fascia is being divided and now you can see the perforator, which must be dissected down to the source vessel, so that when the flap is turned, it's a gentle twist rather than an acute twist. The Doppler is your friend and you can use the Doppler to listen to your perforator, make sure that it's still there at the end of your dissection, and then rotate the flap into the defect. And as mentioned in the text, rotate it in both directions, because sometimes the flap will be happier with a twist in one direction rather than the other. Check your Doppler again, inset your flap, and you're done.
Video Summary
In this procedure, an exploratory incision is used to inspect the perforator before designing a propeller flap for a lower leg defect. The flap is based on the posterior tibial system, with the fascia divided to reveal the perforator. It’s critical to dissect down to the source vessel for a gentle rather than acute twist when rotating the flap. The Doppler device is used to monitor the perforator during dissection and flap rotation. Rotating the flap in both directions is advised to determine optimal placement. Finally, the flap is inset after rechecking with the Doppler.
Keywords
propeller flap
perforator
posterior tibial system
Doppler device
lower leg defect
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