May 7, 2011
School of Medicine, Kochi
Dr. Sachin U. Chavre, postgraduate scholar at the Department of Plastic and Reconstructive Surgery at the Amrita School of Medicine won the best paper award at the 24th Annual Conference of the Kerala Plastic Surgery Association (KPSA) recently conducted in Thrissur.
The award was given for his paper titled Fibula flap donor site defect closure by propeller flap, in the paper presentation category for postgraduate students.
Dr. Sachin’s paper explained and demonstrated the use of a novel technique in plastic surgery, wherein a local propeller flap could be used for covering the fibula flap donor defect.
Surgical defects of the head and neck caused by cancers, infections and trauma are often reconstructed using bone and the skin harvested from fibula, the outer bone of the lower leg.
The length of this bone, consistent blood supply and relative ease of harvest is the reason why the free fibula flap is widely used in osseous reconstructions.
When the flap is harvested however, to cover a defect in the head or neck region, it leaves another defect at the donor site which becomes an aesthetic or even a functional problem for some patients.
“Not much can be done for the functional problem because of the dissection involved in fibula flap,” explained Dr. Sachin. “But for the aesthetic problem, literature has different options including split /full thickness grafting, skin stretching device or tissue expansion. But all these have their limitations.”
Dr. Sachin and his team under the guidance of mentors, Dr. Subramania Iyer and Dr. Mohit Sharma, at the Amrita Department of Plastic and Reconstructive Surgery, devised a local propeller flap to cover the fibula flap donor site defect. Their propeller flap was based on soleus musculocutaneous perforator, which can be easily harvested from the leg.
Propeller flaps allow the coverage of soft-tissue defects of the leg. They can be raised with a relatively simple surgical technique, have a high rate of rate of success and get good cosmetic results without causing any functional impairment.
“The reconstruction of the defect using the propeller flap showed promising results in our set of patients,” stated Dr. Sachin. “Out of ten patients, the propeller flap completely survived in eight patients. There was partial loss of the flap in one patient and a complete loss in another.”
“Earlier, patient defects after fibula flap harvest were grafted with split thickness skin graft. After healing, this left a very ugly scar over the leg that was not at all pleasing to look at. Additionally, this required immobilization during the period of healing, which led to an increased patient stay in the hospital.”
“With the advent of the propeller flap, we have solved all these problems. It gives primary closure, requires no immobilization and heals early. There is learning curve for understanding the flap dissection but once mastered it is safe to practice and administer,” Dr. Sachin concluded.
