title: Perforator flaps in hand reconstruction: the effect of blood vessel twisting.
abstract: OBJECTIVE
  Perforator flaps increasingly find acceptance and use in hand reconstructive surgery. A propeller flap is an island flap that moves from one orientation to another by rotating around its vascular pedicle. It is now possible to design propeller flaps based on a single perforator, so-called "perforator-based propeller flaps," but they are more prone to vascular impairment when twisted more than 90°.
  
  
  METHODS
  We present a prospective study conducted in the Plastic and Reconstructive Surgery Department of the Rehabilitation Hospital over 17 months. All perforator-based propeller flaps that were used for hand reconstruction were analyzed. The parameters studied included the size and location of the defect, the size and shape of the flap, the perforator (length and location) that was used, the degree of twisting of the perforator, the degree of perforator dissection, the management of the donor site, and flap survival area.
  
  
  RESULTS
  In this study we investigated the circulatory impairment induced by twisting of the pedicle on a true perforator flap. All flaps survived completely with the exception of partial skin necrosis in few cases. Some of these cases required debridement and skin grafting.
  
  
  CONCLUSIONS
  Perforator-based propeller flaps provide a reliable option for covering small- to medium-size hand complex tissue defects. They have the advantages of using similar tissues in reconstruction, not damaging another area, they do not require main vessels sacrifice, and the donor site can be generally directly closed.
authors.affiliation: Department of Plastic and Reconstructive Microsurgery, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Filip
authors.initials: F
authors.lastname: Ardelean
authors.affiliation: Department of Plastic and Reconstructive Microsurgery, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Muntean
authors.affiliation: Department of Anatomy, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Dinu
authors.initials: D
authors.lastname: Dumitrascu
authors.affiliation: Department of Health Policy and Public Health, Babes-Bolyai University, Cluj-Napoca, Romania.
authors.forename: Stefan
authors.initials: S
authors.lastname: Strilciuc
authors.affiliation: Department of Plastic and Reconstructive Microsurgery, Clinic of Plastic and Reconstructive Microsurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Alexandru Valentin
authors.initials: AV
authors.lastname: Georgescu
keywords: hand reconstruction; perforator flaps; perforator vessel