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

Extremity soft tissue sarcoma resection often results in complex defects requiring reconstruction to preserve function and support multidisciplinary treatment. Propeller flaps have emerged as a local alternative to free flaps in selected cases, but their role in sarcoma reconstruction remains incompletely defined. This systematic review aimed to assess the current evidence on the indications, reconstructive outcomes, and oncologic reporting of propeller flaps in extremity sarcoma reconstruction. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, and the Cochrane Library in accordance with PRISMA 2020. Studies reporting perforator-based propeller flaps after extremity soft tissue sarcoma resection were included. Data were synthesized descriptively because of the heterogeneity of study design, patient populations, and outcome reporting. Nineteen studies were included. Across the published literature, 656 patients were described overall, including 185 propeller flaps used after sarcoma resection. Most reconstructions involved the lower extremity, accounting for more than 95% of reported cases. Flap survival was generally high; among studies providing extractable numerical data, complete flap survival was 92.7% (115/124), total flap loss was 3.8% (2/52), and partial necrosis occurred in 9.6% (5/52) of flaps. Venous congestion was the most frequently reported complication. Oncologic outcomes were inconsistently reported, and comparative recurrence-related data were very limited. Available data suggest that propeller flaps can provide reliable coverage with acceptable complication rates in selected cases. Oncologic outcomes were sparsely and inconsistently reported, and the current literature does not show a clear signal of increased local recurrence; however, the available evidence is insufficient to draw firm conclusions regarding oncologic safety or equivalence compared with other reconstructive strategies. These findings support consideration of propeller flaps as a complementary reconstructive option in carefully selected patients, although higher-quality studies with standardized oncologic outcomes are needed.