Dual-perforator Pedicled Propeller Flap With a Deep Adipofascial Bridge for Extremity Reconstruction.

Background: Pedicled propeller flaps are widely used for extremity reconstruction but are commonly associated with venous congestion, distal ischemia, and partial necrosis. Although various technical modifications have been proposed to improve venous drainage, some introduce additional technical limitations or compromise flap mobility. In this study, we introduce a refined technique using a dual-perforator pedicled propeller flap incorporating a deep adipofascial bridge to increase venous outflow and flap viability. Methods: Between October 2011 and November 2021, 31 patients underwent soft-tissue reconstruction using a dual-perforator propeller flap with a deep adipofascial bridge. The technique involves identifying 2 perforators (P1 and P2) from a single source vessel, preserving a bridge of deep adipofascial tissue between them to form a composite pedicle, and transposing the flap as a propeller. Results: All flaps were successfully transposed. Postoperative venous congestion was observed in 4 of the 31 flaps (12.9%). Among these 4 cases, congestion resolved spontaneously in 3; 1 flap developed transient venous congestion accompanied by minor tip necrosis (1% partial flap loss), which healed completely with conservative dressing changes. All remaining flaps survived completely without complications, yielding satisfactory functional and aesthetic outcomes. Conclusions: The dual-perforator propeller flap with a deep adipofascial bridge enhances vascular perfusion and venous outflow by preserving an additional axial perforator and a vascularized tissue bridge. This modification enhances flap reliability, increases the safe rotation arc, and reduces the risk of venous congestion, offering a robust nonmicrosurgical option for complex extremity reconstruction.