Extensive Defect Reconstruction Using Multiple Perforator Propeller Flaps in a Jigsaw Puzzle Approach

Background:Reconstruction of extensive defects remains a challenge. The authors report their experience with extensive defect reconstruction using multiple perforator propeller flaps and provide a systematic review of the literature on this approach.Methods:This retrospective study included patients who underwent defect reconstruction with multiple perforator propeller flaps from 2014 to 2021. A systematic review was conducted by retrieving studies on reconstructive strategy from PubMed, Web of Science, Embase, and Scopus published before December 1, 2022.Results:Thirty patients underwent defect reconstruction using 65 perforator propeller flaps. The posterior trunk (66.7%) was the most common site of defects. Complete flap survival was achieved in 61 flaps (93.8%). Partial necrosis of 4 flaps in 3 patients and venous congestion of 1 flap resulted in an overall complication rate of 13.3%. One flap experienced distal tip necrosis in 21 patients undergoing posterior trunk or perineal defect reconstruction, leading to an overall complication rate of 4.7%. Other complications were observed during the reconstruction of defects in the lower extremities (1 of 5 patients) and anterior trunk (2 of 4 patients). In the systematic review, 11 articles involving 74 patients were identified. Commonly reported locations of the defects were the perineum (55.4%) and posterior trunk (33.8%). Flap-related complications included venous congestion; no flaps were lost.Conclusion:This study on the use of multiple perforator propeller flaps in a jigsaw puzzle approach demonstrated that the method can be used effectively for extensive posterior trunk and perineal defect reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, III.