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

BACKGROUND: 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. METHODS: The authors performed a monocentric prospective study to evaluate patients who underwent propeller flap surgery and studied the relationship between flap necrosis and patients' preoperative biological markers (hemoglobin and hematocrit). They also looked into patients' risk factors and the risks for flap necrosis, including smoking, radiation therapy, malignancy, harvesting time, direction and angle of rotation, and preoperative hemoglobin and hematocrit values. RESULTS: This study analyzed 144 patients of different ages (range, 8 to 85 years; mean age, 45.03 years) over a 6-year follow-up period (November of 2018 to November of 2024). Preoperative hemoglobin and hematocrit levels were noted, and postoperative flap monitoring was conducted. The authors observed 32 necrosis cases (22.2%), with 23 cases of partial necrosis (16%) and 9 cases of total necrosis (6.25%). The hematocrit rate and the hemoglobin level had no significant effect on the risk of occurrence of necrosis. Patients were significantly older in the necrosis group (OR, 4.53; P = 0.02). The risk of necrosis also increased significantly with increasing arc of rotation (OR, 1.01 for each degree of increase; P = 0.002). CONCLUSIONS: This study highlighted that the hematocrit rate and the hemoglobin level do not seem to have a significant influence on the risk of necrosis. Other factors that could influence the risk of necrosis occurring include the age of the patient and the angle of rotation. Previous studies in the literature did not analyze the patient's biological markers in relation to flap necrosis and complications.