Propeller Flaps in Extremity Sarcoma Reconstruction: A Systematic Review of Reconstructive Outcomes and Oncologic...

Area of Science:

• Orthopedic Oncology
• Plastic and Reconstructive Surgery
• Surgical Oncology

Background:

• Extremity soft tissue sarcoma resection frequently leads to complex defects necessitating functional reconstruction.
• Propeller flaps are a local reconstructive option, but their efficacy in sarcoma cases is not fully established.

Purpose of the Study:

• To systematically review the evidence on propeller flap use in extremity soft tissue sarcoma reconstruction.
• To assess indications, reconstructive outcomes, and oncologic reporting of these flaps.

Main Methods:

• Systematic literature search of PubMed/MEDLINE, Scopus, and Cochrane Library (PRISMA 2020).
• Inclusion of studies reporting perforator-based propeller flaps after sarcoma resection.
• Descriptive synthesis of data due to heterogeneity.

Main Results:

• 19 studies included 656 patients, with 185 propeller flaps used, primarily in lower extremity reconstructions.
• High flap survival rates (92.7% complete survival), with venous congestion as the most common complication.
• Inconsistent and limited oncologic outcome reporting, with no clear signal of increased local recurrence but insufficient evidence for firm conclusions.

Conclusions:

• Propeller flaps can provide reliable coverage for extremity sarcomas with acceptable complication rates in selected patients.
• Current evidence is insufficient to definitively assess oncologic safety or equivalence compared to other methods.
• Higher-quality studies with standardized oncologic outcomes are needed to support propeller flap use in sarcoma reconstruction.