Propeller flaps in soft tissue sarcoma’s defects: Analysis and discussion of current literature
Keywords:
Propeller flaps, Soft tissue sarcoma’s defects, Safety distance in resection, Free flaps, Reconstructive microsurgery, Local tissue transferAbstract
Background and Aim: Propeller flaps have been described as local flaps for soft tissue reconstruction in various anatomical regions, defined as “an island flap that reaches the recipient site through an axial rotation.” The distinctive feature of propeller flaps compared to other pedicled flaps lies in their rotation around a central pivot point. Due to their versatility, ability to achieve like-to-like reconstruction, and minimal donor-site morbidity, propeller flaps have gained widespread use in reconstructive surgery for traumatic defects, tumor excisions, burns, and infections. The aim of this study was to evaluate the outcomes of propeller flaps in oncological reconstruction and to compare them with free flap procedures.
Methods: A retrospective analysis was conducted on 38 patients affected by soft tissue sarcomas who underwent reconstructive surgery following tumor excision. Nineteen patients (50%) were treated with propeller flaps and nineteen (50%) with free flaps. Clinical outcomes, including flap survival, complication rates, and salvage procedures, were assessed and compared between the two groups.
Results: Both propeller and free flaps achieved satisfactory reconstructive outcomes with comparable rates of flap survival. Propeller flaps demonstrated reduced operative time and donor site morbidity, while maintaining acceptable safety and reliability in oncological settings. Complications were effectively managed with conservative or minor surgical interventions, and overall salvage rates were consistent with data reported in the literature.
Conclusions: Propeller flaps represent a reliable and versatile reconstructive option in oncological soft tissue surgery, offering a valid alternative to free flaps in selected patients. Their use allows adequate defect coverage with minimal donor site morbidity and satisfactory functional and aesthetic outcomes, supporting their role as a safe and efficient technique in modern reconstructive oncology.
References
1. Hyakusoku H and Shimpei O. The history of propeller flaps. Seminars in Plastic Surgery. Vol. 34. No. 03. Thieme Medical Publishers, 2020.
2. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987 Mar;40(2):113-41. doi: 10.1016/0007-1226(87)90185-8
3. Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg. 2009 Nov;124(5):1529-1544. doi: 10.1097/PRS.0b013e3181b98a6c
4. Blondeel PN, Van Landuyt KH, Monstrey SJ et al. The "Gent" consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003 Oct;112(5):1378-83; quiz 1383, 1516; discussion 1384-7.doi: 10.1097/01.PRS.0000081071.83805.B6
5. Hallock Geoffrey G. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Annals of plastic surgery 56.5 (2006): 540-542. doi: 10.1097/01.sap.0000210512.81988.2b
6. Hyakusoku H, Ogawa R, Oki K, Ishii N. The perforator pedicled propeller (PPP) flap method: report of two cases. J Nippon Med Sch. 2007 Oct;74(5):367-71. doi: 10.1272/jnms.74.367
7. Pignatti M, Ogawa R, Hallock GG, et al. The "Tokyo" consensus on propeller flaps. Plast Reconstr Surg. 2011 Feb;127(2):716-722. doi: 10.1097/PRS.0b013e3181fed6b2
8. Toia F, D'Arpa S, Pignatti M, Noel W, Cordova A. Axial propeller flaps: A proposal for update of the "Tokyo consensus on propeller flaps". J Plast Reconstr Aesthet Surg. 2017 Jun;70(6):857-860. doi: 10.1016/j.bjps.2017.02.007.
9. Pignatti M, Ogawa R, Mateev M, et al. Our Definition of Propeller Flaps and Their Classification. Semin Plast Surg. 2020 Aug;34(3):139-144. doi: 10.1055/s-0040-1715158
10. Teo TC. The propeller flap concept. Clin Plast Surg. 2010 Oct;37(4):615-26, vi. doi: 10.1016/j.cps.2010.06.003
11. Georgescu AV, Matei I, Ardelean F, Capota I. Microsurgical non microvascular flaps in forearm and hand reconstruction. Microsurgery. 2007;27(5):384-94. doi: 10.1002/micr.20376
12. Artiaco S, Battiston B, Colzani G, et al. Perforator based propeller flaps in limb reconstructive surgery: clinical application and literature review. Biomed Res Int. 2014;2014:690649. doi: 10.1155/2014/690649
13. Cavadas PC, Teran-Saavedra PP. Combined latissimus dorsi-thoracodorsal artery perforator free flap: the "razor flap". J Reconstr Microsurg. 2002 Jan;18(1):29-31. doi: 10.1055/s-2002-19706
14. D'Arpa S, Toia F, Pirrello R, Moschella F, Cordova A. Propeller flaps: a review of indications, technique, and results. Biomed Res Int. 2014;2014:986829. doi: 10.1155/2014/986829
15. Bekara F, Herlin C, Mojallal A, et al. A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects: Identification of Risk Factors for Complications. Plast Reconstr Surg. 2016 Jan;137(1):314-331. doi: 10.1097/PRS.0000000000001891
16. Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg. 2007 Dec;59(6):672-8. doi: 10.1097/SAP.0b013e31803df4e9
17. Pignatti M, Pinto V, Docherty Skogh AC, et al. How to Design and Harvest a Propeller Flap. Semin Plast Surg. 2020 Aug;34(3):152-160. doi: 10.1055/s-0040-1714271
18. Lazzeri D, Huemer GM, Nicoli F, et al. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: a systematic review. Arch Plast Surg. 2013 Jan;40(1):44-50. doi: 10.5999/aps.2013.40.1.44
19. Gir P, Cheng A, Oni G, Mojallal A, Saint-Cyr M. Pedicled-perforator (propeller) flaps in lower extremity defects: a systematic review. J Reconstr Microsurg. 2012 Nov;28(9):595-601. doi: 10.1055/s-0032-1315786
20. Sisti A, D'Aniello C, Fortezza L, et al. Propeller Flaps: A Literature Review. In Vivo. 2016 Jul-Aug;30(4):351-73. PMID: 27381596
21. Cajozzo M, Jiga LP, Jandali Z, et al. Complications and Solutions in Propeller Flap Surgery. Semin Plast Surg. 2020 Aug;34(3):210-220. doi: 10.1055/s-0040-1714087
22. Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction? Clin Orthop Relat Res. 2014 Jul;472(7):2276-86. doi: 10.1007/s11999-014-3537-6
23. O'Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002 Jun 29;359(9325):2235-41. doi: 10.1016/S0140-6736(02)09292-9
24. Lonie S, Grinsell D, Mah E. Propeller flap reconstruction of irradiated sarcoma defects: A comparison. J Plast Reconstr Aesthet Surg. 2019 Feb;72(2):181-187. doi: 10.1016/j.bjps.2018.10.011
25. Innocenti M, Dell'Acqua I, Famiglietti M, Vignini L, Menichini G, Ghezzi S. Free perforator flaps vs propeller flaps in lower limb reconstruction: A cost/effectiveness analysis on a series of 179 cases. Injury. 2019 Dec;50 Suppl 5:S11-S16. doi: 10.1016/j.injury.2019.10.039
26. Pinto V, Zeneli F, di Summa PG, et al. Microsurgical Reconstruction with and without Microvascular Anastomosis of Oncological Defects of the Upper Limb. Healthcare (Basel). 2024 Oct 15;12(20):2043. doi: 10.3390/healthcare12202043
27. Yu S, Zang M, Xu L, et al. Perforator Propeller Flap for Oncologic Reconstruction of Soft Tissue Defects in Trunk and Extremities. Ann Plast Surg. 2016 Oct;77(4):456-63. doi: 10.1097/SAP.0000000000000649
28. Bekara F, Herlin C, Somda S, de Runz A, Grolleau JL, Chaput B. Free versus perforator-pedicled propeller flaps in lower extremity reconstruction: What is the safest coverage? A meta-analysis. Microsurgery. 2018 Jan;38(1):109-119. doi: 10.1002/micr.30047
29. Tiengo C, Sonda R, Messana F, et al. Risk of translocated soft-tissue sarcoma recurrence using perforator propeller flap: Case report and literature review. SAGE Open Medical Case Reports. 2020;8. doi:10.1177/2050313X20970021
30. McKee MD, Liu DF, Brooks JJ, Gibbs JF, Driscoll DL, Kraybill WG. The prognostic significance of margin width for extremity and trunk sarcoma. J Surg Oncol. 2004 Feb;85(2):68-76. doi: 10.1002/jso.20009
31. Hofer SO, Molema G, Hermens RA, Wanebo HJ, Reichner JS, Hoekstra HJ. The effect of surgical wounding on tumour development. Eur J Surg Oncol. 1999 Jun;25(3):231-43. doi: 10.1053/ejso.1998.0634
32. Mokbel K, Choy C, Engledow A. The effect of surgical wounding on tumour development. Eur J Surg Oncol. 2000 Mar;26(2):195. doi: 10.1053/ejso.1999.0771
33. Cha HG, Kang MK, Kim W, Lee JS, Hong JP, Suh HP. Oncologic safety of propeller flap and free flap in reconstruction after soft tissue sarcoma resection. J Surg Oncol. 2020 Sep;122(4):787-794. doi: 10.1002/jso.26076
34. Tos P, Innocenti M, Artiaco S, Antonini A, Delcroix L, Geuna S, Battiston B. Perforator-based propeller flaps treating loss of substance in the lower limb. J Orthop Traumatol. 2011 Jun;12(2):93-9. doi: 10.1007/s10195-011-0136-0
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Chiara Asti, Corrado Ciatti, Fabrizio Quattrini, Luca Rosato, Valeria Navach, Sara Coppola, Elisabetta Pennacchioli, Cristina Garusi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
