Introduction
Propeller flaps have a higher-than-normal incidence of partial flap necrosis and while venous supercharging has been shown to reduce this risk, its application is limited outside the scope of lower limb propeller flaps. In this article, we look at the ability of arborization capture and supermicrosurgery to allow propeller flaps to capture adjacent perforasomes and significantly improve flap survival.

Patients & Methods
In a retrospective case series across two institutions, the outcomes of two groups of patients who had propeller flaps were compared. Group ‘A’ were those who had conventional free-styled propeller flaps (n = 25) while Group ‘B’ (n = 19) were patients who had propeller flaps algorithmically selected for either (i) arborization capture and/or (ii) venous supercharging. Two-way ANOVA analysis was performed to evaluate inter-group differences.

Results
Conventional propeller flaps had a 64% complete survival rate (32% partial necrosis rate and a 4% total necrosis rate) compared to a 94 % complete survival rate in modified propeller flaps. Of the twelve cases of arborization capture (perforator complex diameters of 1 to 2 mm), only one flap sustained partial flap loss while all seven supercharged propeller flaps (selected for perforator diameter < 1 mm, with venous supercharging, in addition to arborization capture) survived completely.

Conclusion
The arborization technique should be the mainstay technique for all propeller flaps with perforator complex diameters of less than 2mm while supercharging further enhances its survival, particularly in perforator complex diameters of < 1 mm.