title: A review of propeller flaps for distal lower extremity soft tissue reconstruction: Is flap loss too high?
abstract: Soft tissue coverage in the distal lower extremity remains a significant challenge. While free flaps are often utilized for larger defects, local perforator-based propeller flaps may be ideal for smaller wounds requiring coverage. Propeller flaps can provide excellent form and function for both traumatic and atraumatic defects with minimal donor site morbidity but can have concerning rates of flap loss. We reviewed the literature, identifying 21 studies presenting 310 propeller flaps for distal lower extremity reconstruction. Total flap necrosis was noted in 5.5% of flaps, with partial necrosis in 11.6%. While these flaps do enable transfer of local, healthy tissue to the defect site without the need for a microsurgical anastomosis, this rate of flap loss is concerning and appropriate patient selection is crucial. This review provides a brief history and overview of the clinical application and research into distal lower extremity perforator propeller flaps to place this technique into a clinical context.
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. jonas.nelson@uphs.upenn.edu
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Brazio
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.affiliation: Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
authors.affiliation: Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Ariel N
authors.initials: AN
authors.lastname: Rad
mesh_terms: D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery; D008297:Male; D061525:Perforator Flap / Q000009:adverse effects / Q000098:blood supply / Q000637:transplantation*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology