title: Propeller Flaps: A Literature Review.
abstract: OBJECTIVE
  Since their introduction in 1991, propeller flaps are increasingly used as a surgical approach to loss of substance. The aim of this study was to evaluate the indications and to verify the outcomes and the complication rates using this reconstructing technique through a literature review.
  
  
  METHODS
  A search on PubMed was performed using "propeller flap", "fasciocutaneous flap", "local flap" or "pedicled flap" as key words. We selected clinical studies using propeller flaps as a reconstructing technique.
  
  
  RESULTS
  We found 119 studies from 1991 to 2015. Overall, 1,315 propeller flaps were reported in 1,242 patients. Most frequent indications included loss of substance following tumor excision, repair of trauma-induced injuries, burn scar contractures, pressure sores and chronic infections. Complications were observed in 281/1242 patients (22.6%) occurring more frequently in the lower limbs (31.8%). Partial flap necrosis and venous congestion were the most frequent complications. The complications' rate was significantly higher in infants (<10 years old) and in the older population (>70 years old) but there was not a significant difference between the sexes. Trend of complication rate has not improved during the last years.
  
  
  CONCLUSIONS
  Propeller flaps showed a great success rate with low morbidity, quick recovery, good aesthetic outcomes and reduced cost. The quality and volume of the transferred soft tissue, the scar orientation and the possibility of direct donor site closure should be considered in order to avoid complications. Indications for propeller flaps are small- or medium-sized defects located in a well-vascularized area with healthy surrounding tissues.
authors.affiliation: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy asisti6@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sisti
authors.affiliation: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: D'Aniello
authors.affiliation: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Fortezza
authors.affiliation: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors.forename: Juri
authors.initials: J
authors.lastname: Tassinari
authors.affiliation: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cuomo
authors.affiliation: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Grimaldi
authors.affiliation: Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nisi
mesh_terms: D006801:Humans; D008866:Microsurgery / Q000379:methods*; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: Propeller flaps; fasciocutaneous flap; island flaps; local flaps; pedicled flap; perforator flap; review; surgical flaps