What question did this study set out to answer?

To evaluate the effectiveness and safety of perforator-based propeller flaps for reconstructing distal leg and ankle defects.

March 1, 2026

“Optimizing Perforator-Based Propeller Flap Design for Distal Leg, Ankle and Hindfoot Reconstruction: A Systematic Review and Meta-Analysis”

Q: What does this research mean for the field?

Perforator-based propeller flaps (PPF) have a low total flap necrosis rate of 2% and are dependable single-stage alternatives to free flaps for distal lower-extremity defects. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Key Points

To evaluate the effectiveness and safety of perforator-based propeller flaps for reconstructing distal leg and ankle defects.
Systematic review of existing literature on perforator-based propeller flaps
Meta-analysis to quantify outcomes across different studies
Evaluation of flap dimensions, necrosis rates, and grafting outcomes
Total flap necrosis rate observed was low at 2%
Most partial losses managed successfully with skin grafts
Optimal flap dimensions maintained between 40-80 cm² and width > 4.5 cm
Flap-to-defect ratio less than 2.5 confirmed as crucial for positive outcomes

Abstract

PPF show a low total flap necrosis rate (2%), with most partial losses closed by skin grafting. Keeping flap dimension within 40-80 cm², width > 4.5 cm, and flap-to-defect ratio < 2.5 preserves optimal outcomes, confirming PPF as dependable single-stage alternatives to free flaps for distal lower-extremity defects.Clinical Question/Level of Evidence: Therapeutic, Level III.

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“Optimizing Perforator-Based Propeller Flap Design for Distal Leg, Ankle and Hindfoot Reconstruction: A Systematic Review and Meta-Analysis”

Key Points

Abstract

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