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Related Concept Videos

Bones of the Lower Limb: Tibia and Fibula01:10

Bones of the Lower Limb: Tibia and Fibula

The tibia is the main weight-bearing bone of the lower leg. It is larger than the fibula with which it is paired. The tibia is also the second longest bone in the body and is located right below the skin. The proximal end of the tibia forms the medial and the lateral condyle, which articulates with the condyles of the femur to form the knee joint. Between the articulating surfaces is the irregular elevated area known as the intercondylar eminence that serves as the inferior attachment point for...

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Related Experiment Video

Updated: May 13, 2026

Engineered Vascularized Muscle Flap
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"Optimizing Perforator-Based Propeller Flap Design for Distal Leg, Ankle and Hindfoot Reconstruction: A Systematic

Sheng-Chi Huang1, Yun-Shan Yeh1, Wen-Hsuan Chen1

  • 1Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

Plastic and Reconstructive Surgery
|February 27, 2026
PubMed
Summary

Perforator-based propeller flaps (PPF) offer reliable reconstruction for lower-extremity defects. Optimal design parameters like flap width >4.5 cm and dimension 40-80 cm² minimize complications, ensuring dependable outcomes.

Keywords:
Propeller flaplower extremity reconstructionmeta-analysisperforator flapperoneal arteryposterior tibial artery

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Microsurgery

Background:

  • Perforator-based propeller flaps (PPF) are crucial for reconstructing distal lower-extremity defects.
  • Optimal PPF design parameters and their impact on complications require further clarification.
  • This study provides evidence-based guidelines for PPF design.

Purpose of the Study:

  • To systematically review and meta-analyze individual patient data on PPF outcomes.
  • To establish evidence-based guidelines for PPF design.
  • To identify optimal design parameters influencing complication rates.

Main Methods:

  • Systematic review and meta-analysis of individual patient data.
  • Searched PubMed, Embase, and Cochrane Library up to March 2025.
  • Included 402 PPFs from 27 studies, analyzing outcomes like target site complications (TSC) and flap necrosis.

Main Results:

  • Overall TSC rate was 22%, with flap necrosis at 12%.
  • Lower complication rates correlated with flap width >4.5 cm (22%), flap dimension 40-80 cm² (18%), and flap-to-defect ratio <2.5 (16%).
  • Venous congestion occurred in 4% of cases.

Conclusions:

  • PPF demonstrate a low total flap necrosis rate of 2%.
  • Optimal outcomes are achieved with flap dimensions of 40-80 cm², width >4.5 cm, and flap-to-defect ratio <2.5.
  • PPF are dependable single-stage alternatives to free flaps for distal lower-extremity reconstruction.