DS08 Expanding the reconstructive armamentarium: a case series utilizing the pretragal perforator propeller flap

Abstract The superficial temporal artery pretragal propeller flap is a rarely described example of a perforator flap, which has broad utility in the reconstruction of defects of the upper lateral cheek, lower temple, zygomatic cheek and ear (including two-stage repair). A propeller flap is defined as an island flap reaching the recipient site through axial rotation, differentiating it from other pedicled flaps. The flap has a wide rotation arc with excellent mobility, and is described by the nature of the pedicle, degree of skin island rotation (usually acentric axis) and artery of origin of the perforator vessel(s). If the source vessel is not known (i.e. free-style design), then the anatomical region or underlying muscle is specified. Some surgeons advocate direct visualization of perforators with or without use of a Doppler probe if > 90° twist of pedicle is needed. However, in our five cases we achieved a 100% viable flap without direct perforator visualization, or use of a Doppler. We demonstrate variants of a myosubcutaneous pretragal perforator propeller (PTPP) flap utilizing the lower lateral cheek reservoir, in the reconstruction of five cases. The patients were a 47-year-old woman with a PTPP flap for a 45 × 23-mm lateral upper-cheek Mohs defect, an 81-year-old man with a tunnelled PTPP flap for a 36 × 33-mm left lower-temple defect, a 76-year-old woman with a two-stage interpolated PTPP flap for a left upper-antihelix 15 × 25-mm defect, a 77-year-old man with interpolated two-stage PTPP flap repair after a right superolateral helix wedge excision with a 30 × 34-mm defect, and a 68-year-old woman with a two-stage interpolated PTPP flap for a left upper-antihelix 20 × 20-mm defect. The degree of rotation arc in the cases was between 90° and 170°. At 3 months after reconstruction, the mean overall Patient and Observer Scar Assessment Scale score was 1.6 out of 10 for patients and 2.2 out of 10 for observers. The PTPP flap has several attributes: transfer of tension to a secondary defect where there is more redundancy and direct closure is possible without compromising free margins, closing like-with-like skin, and restoring contour with minimal sacrifice of surrounding normal skin. Women appear to demonstrate more optimal cosmesis due to the caveat of hair-bearing cheek skin in men. We suggest that the PTPP flap is a useful addition to the reconstructive armamentarium of dermatological surgeons.