Systematic review evaluates outcomes of perforator-based propeller flaps in lower extremity reconstruction, suggesting they are reliable alternatives to free flaps.
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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Huang et al. (2026) studied this question.
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