ARTICLE IN PRESS JID: JINJ [m5G;November 9, 2019;9:16] Injury xxx (xxxx) xxx Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury Why, when and how propeller perforator flaps in reconstructive surgery  Alexandru Valentin Georgescu a,b , Ileana Rodica Matei a,b,* , Marko Bumbasirevic c,d , N Panayotis Soucacos e a Department of Plastic Surgery and Reconstructive Microsurgery, University of Medicine Iuliu Hatieganu Cluj Napoca, Romania b Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Hospital of Recovery, Cluj Napoca, Romania c Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Serbia d School of Medicine. University of Belgrade, Serbia e “Panayotis N. Soucacos” Orthopaedic Research & Education Center (OREC), National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece a r t i c l e i n f o Article history: Available online xxx Key words: Tissue defects Microsurgical non-microvascular flaps Propeller perforator flaps a b s t r a c t Purpose: The aim of this paper was to evaluate the outcomes of propeller perforator flaps used all over the body, and to appreciate their advantages and/or disadvantages over the free perforator flaps. Method: Patients that required propeller perforator flaps used all over the body were eligible to par- ticipate in this study. A preoperative Doppler examination was performed for all the flaps in the trunk and thigh, but not regularly in the face, lower leg, foot, forearm and hand. We evaluated the most im- portant technical aspects of harvesting the flaps, the main indications and advantages of using propeller perforator flaps, their disadvantages and complications. For post-excisional face and trunk defects after cancer or decubitus ulcers were performed approxi- mately 25% of flaps. Results: We had very good results in approximately 70% of cases. In the remaining cases, excepting 3 cases in which the flaps were completely lost, we registered only minor complications due to venous congestion, which were solved spontaneously or by skin grafting. Conclusion: The main advantages of propeller perforator flaps, i.e. no need of microvascular anastomoses, replacing like-with-like, faster functional rehabilitation, can reduce in well selected cases the indication for free flaps. The rate of complications is not higher than by using other methods. The single real disad- vantage of propeller perforator flaps is the location of the perforator close to the defect, what can be an impediment in trauma cases. © 2019 Elsevier Ltd. All rights reserved. Introduction A good reconstruction of missing skin and/or other tissues means to find the shortest way and use top quality tissues to ob- tain the best possible morphological and functional result. That means to use for reconstruction as similar as possible tissues and with absent or very low donor site morbidity. The advances in blood supply knowledge and in microsurgi- cal techniques in the last three decades allowed the development  This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Micro- surgery (SSRM). * Corresponding author at: Matei Ileana Rodica, Spitalul Clinic de Recuperare, Str. Viilor 46-50, 400347 Cluj Napoca, Cluj, Romania. E-mail address: irmatei@yahoo.com (I.R. Matei). of new and more reliable surgical methods in covering simple or complex tissue defects all over the body. Starting with the first perforator flaps performed by Kroll and Rosenfield in 1988 [1] and Koshima and Soeda in 1989 [2], the new era of perforator flaps began. The rational of using these flaps was represented by the diminution of donor site morbidity by sparing the muscles and the main arterial trunks. The perforator flaps have been used initially as free flaps, which very much reduced the donor site morbidity, but which responded only partially to another necessity: the replacement of like-with- like. That’s why a new type of perforator flaps was developed – the local perforator flaps – which allow the reconstruction by us- ing identical or very similar tissues. The aim of this paper was to demonstrate why, when and how the local perforator flaps used in a propeller manner can be used in the reconstruction of tissue defects all over the body [3,4]. https://doi.org/10.1016/j.injury.2019.10.037 0020-1383/© 2019 Elsevier Ltd. All rights reserved. Please cite this article as: A.V. Georgescu, I.R. Matei and M. Bumbasirevic et al., Why, when and how propeller perforator flaps in reconstructive surgery, Injury, https://doi.org/10.1016/j.injury.2019.10.037