Case 10 2026: Propeller Flap Based on Two Perforators of the Scapular Artery for the Management of a Severely Traumatized Upper Extremity

Nelson Ramirez Lozano

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Case 10 2026: Propeller Flap Based on Two Perforators of the Scapular Artery for the Management of a Severely Traumatized Upper Extremity · JPBRS

Case report

Case 10 2026: Propeller Flap Based on Two Perforators of the Scapular Artery for the Management of a Severely Traumatized Upper Extremity

Nelson Ramirez Lozano¹

¹Hospital de Santa Sofía Manizales, Colombia. Alejandro Angelillis Osorio. Surgical Assistant, Oncologos de Occidente, Manizales, Colombia

Published April 15, 2026946 views3 min read

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Abstract

We present the successful case of a patient who sustained severe trauma to the upper extremity caused by a sugarcane mill (trapiche). We consider this type of trauma to be a reconstructive challenge given the significant degree of soft tissue compromise, the presence of infection in nearly all such cases, and the imperative need for these patients to return to their daily activities. A propeller flap based on two perforators of the scapular artery was designed and executed, enabling adequate reconstruction and wound coverage without generating donor-site morbidity, facilitating early rehabilitation and rapid functional recovery. Patient medical history A male patient sustained severe trauma to the left upper extremity involving a sugarcane mill during occupational activities. He was admitted to the emergency department, where hemostasis was achieved and hemodynamic stabilization was attained. On initial evaluation, no fractures were identified; however, the patient presented with humeral bone exposure, circumferential soft tissue loss involving the upper arm, restricted range of motion, and altered sensation. He subsequently underwent multiple irrigation and debridement procedures, as well as serial negative pressure wound therapy (NPWT) dressing changes performed by the Orthopedics and Traumatology service, achieving adequate control of necrotic tissue and resolution of infection. Plastic Surgery consultation was then requested. Before and After Patient examination The patient presented with a circumferential soft tissue defect of the left upper arm with exposed humerus, no active signs of infection, and an in-situ negative pressure wound therapy device. Physical examination a

Key learning points

Pearls

Meticulous microvascular dissection of the perforator vessels
Preservation of the musculature in its entirety whenever feasible

Pitfalls

Prevention of perforator kinking during flap rotation
Pre-operative management and resolution of infection prior to flap coverage

Patient history

A male patient sustained severe trauma to the left upper extremity involving a sugarcane mill during occupational activities. He was admitted to the emergency department, where hemostasis was achieved and hemodynamic stabilization was attained. On initial evaluation, no fractures were identified; however, the patient presented with humeral bone exposure, circumferential soft tissue loss involving the upper arm, restricted range of motion, and altered sensation. He subsequently underwent multiple irrigation and debridement procedures, as well as serial negative pressure wound therapy (NPWT) dressing changes performed by the Orthopedics and Traumatology service, achieving adequate control of necrotic tissue and resolution of infection. Plastic Surgery consultation was then requested.

Examination

The patient presented with a circumferential soft tissue defect of the left upper arm with exposed humerus, no active signs of infection, and an in-situ negative pressure wound therapy device. Physical examination at the time of plastic surgery evaluation revealed no restriction in range of motion and no sensory deficits.

Pre-operative considerations

Given that this was a rural worker, the reconstructive plan was designed with the following objectives:

Adequate coverage of the exposed humerus
Avoidance of additional donor-site morbidity by foregoing muscle flap harvest
Utilization of a perforator-based flap to allow rapid postoperative recovery

Step 1 — Flap Design

References

Marr KL, Varga A, Dumestre DO. The Dorsal Scapular Artery Perforator Flap: A Complete Muscle-sparing Technique. Plast Reconstr Surg Glob Open. 2021 Nov 24;9(11):e3933. doi: 10.1097/GOX.0000000000003933. PMID: 34840920; PMCID: PMC8613356.
Teo TC. The propeller flap concept. Clin Plast Surg. 2010 Oct;37(4):615-26, vi. doi: 10.1016/j.cps.2010.06.003. PMID: 20816517.

How to cite this article

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Case 10 2026: Propeller Flap Based on Two Perforators of the Scapular Artery for the Management of a Severely Traumatized Upper Extremity

Abstract

Key learning points

Patient history

Examination

Pre-operative considerations

Step 1 — Flap Design

References

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Step 2 — 2

Step 3 — 3

Step 4 — 4

Post-operative plan

Pearls

Pitfalls