Major Risk Factors in the Development of Propeller Flap Necrosis: A Prospective Monocentric Study of 144 Flaps

Introduction: Propeller flaps have become increasingly popular with lower donor site morbidity, flexibility in flap design, and lower operating time. A disadvantage remains partial or total flap necrosis with reconstruction failure. Materials and method: We performed a monocentric prospective study that evaluated patients who underwent propeller flap, and we studied the relationship between flap necrosis and the patients’ preoperative biological markers (hemoglobin and hematocrit). We also looked into patients’ risk factors, and the risk for flap necrosis including smoking, radiation therapy, malignancy, harvesting time, direction and angle of rotation, and the preoperative rates of hemoglobin and hematocrit. Results: This study analyzed 144 patients of different ages (range 8-85 years, mean age 45.03) on a 6-year follow-up period (November 2018-2024). Preoperative hemoglobin and hematocrit levels were noted, and post-operative flap monitoring was conducted. We observed 32 necrosis cases (22.2%) with 23 partial necrosis (16%), and nine total necrosis (6.25%). The hematocrit rate and the hemoglobin level do not have a significant effect on the risk of occurrence of necrosis. Patients were significantly older in the necrosis group (OR = 4.53; p-value = 0.02). The risk of necrosis also increased significantly with increasing arc of rotation (OR = 1.01 for each degree of increase; p-value = 0.002). Conclusion: Our study highlighted that the hematocrit rate and the hemoglobin level did not seem to significantly influence the risk of necrosis. Another factors could influence the risk of occurrence of necrosis such as the age of the patients and the angle of rotation. In literature, previous studies did not analyze the patient’s biological markers in relation to flap necrosis and complications. Level of evidence III: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group