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

Keywords: arm, perforator flap, mangled, flap, plastic surgery Authors: Nelson Ramirez Lozano. Plastic Surgery, Oncólogos de Occidente Manizales, Hospital de Santa Sofía Manizales, Colombia. Alejandro Angelillis Osorio. Surgical Assistant, Oncologos de Occidente, Manizales, Colombia. 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