Matarazzo Sara, Corsini Beatrice, Cozzi Silvia, Tellarini Annachiara, Valdatta Luigi, Paganini Ferruccio
Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy.
J Clin Med. 2025 Sep 5;14(17):6288. doi: 10.3390/jcm14176288.
Propeller perforator flaps (PPFs) have gained increasing popularity in lower limb reconstruction. While their use in elective settings is well described, their role in acute post-traumatic reconstruction remains less defined. A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Cochrane Library were searched on 2 June 2025, for studies reporting on the use of propeller flaps in lower limb reconstruction after trauma. Only studies rated as "good" quality using the NIH quality assessment tool were included. Data on anatomical location, flap survival, complications, reinterventions, and functional and patient-reported outcomes were extracted and analyzed descriptively. Twenty-eight studies published between 2008 and 2024 were included, accounting for 619 propeller flaps in a population of 838 patients. The majority of flaps were fasciocutaneous, with the posterior tibial artery being the most commonly used source vessel. Among the flaps included, 422 (68.2%) achieved complete survival without necrosis, 84 (13.6%) developed partial necrosis, and 23 (3.7%) failed completely. Considering all flaps that remained viable after any required revisions or conservative management, the overall survival rate was 97%. Venous congestion was the leading cause of flap compromise. The overall complication rate was 21.8%, increasing to 35.1% in acute trauma cases. A statistically significant correlation was found between wide rotation angles (≥150°) and higher complication rates ( = 0.015). The mean follow-up duration was 12.5 months. Functional and aesthetic outcomes were poorly reported, but when available, they were generally favorable. PPFs represent a valuable option for lower limb reconstruction, providing reliable coverage while preserving major vascular axes. Their application in acute trauma settings appears promising, although current evidence is limited by small verified cohorts and predominantly retrospective study designs. Despite higher complication rates in acute cases, flap survival remains consistently high, supporting their use in carefully selected patients. Further prospective studies with standardized outcome reporting are needed to clarify long-term functional results and refine selection strategies.
螺旋桨穿支皮瓣（PPFs）在下肢重建中的应用越来越广泛。虽然其在择期手术中的应用已有详细描述，但其在急性创伤后重建中的作用仍不太明确。按照PRISMA 2020指南进行了一项系统综述。于2025年6月2日在PubMed、Scopus和Cochrane图书馆中检索关于创伤后下肢重建中使用螺旋桨皮瓣的研究报告。仅纳入使用美国国立卫生研究院质量评估工具评定为“良好”质量的研究。提取并描述性分析有关解剖位置、皮瓣存活情况、并发症、再次干预以及功能和患者报告结局的数据。纳入了2008年至2024年发表的28项研究，涉及838例患者中的619个螺旋桨皮瓣。大多数皮瓣为筋膜皮瓣，胫后动脉是最常用的供血血管。在所纳入的皮瓣中，422个（68.2%）完全存活且无坏死，84个（13.6%）发生部分坏死，23个（3.7%）完全失败。考虑到所有经任何必要的修复或保守处理后仍存活的皮瓣，总体存活率为97%。静脉淤血是皮瓣出现问题的主要原因。总体并发症发生率为21.8%，在急性创伤病例中升至35.1%。发现宽旋转角度（≥150°）与较高并发症发生率之间存在统计学显著相关性（P = 0.015）。平均随访时间为12.5个月。关于功能和美学结局的报告较少，但如有相关报告，通常结果良好。PPFs是下肢重建的一种有价值的选择，在保留主要血管轴的同时提供可靠的覆盖。其在急性创伤情况下的应用似乎很有前景，尽管目前的证据受限于经核实的小队列和主要为回顾性的研究设计。尽管急性病例中的并发症发生率较高，但皮瓣存活率一直很高，支持在精心挑选的患者中使用。需要进一步开展具有标准化结局报告的前瞻性研究，以阐明长期功能结果并完善选择策略。
