Freestyle pedicle perforator flaps: clinical results and vascular anatomy

Perforator flaps have increased in use, with advantages such as sparing of the underlying muscle with resultant decreased donor-site morbidity and the possibility of improving aesthetic outcome. Theoretically, a flap can be based on any perforator, whether free or pedicled, based on the perforasome theory. In this study, the principle of free-style perforator flaps was used to harvest pedicled flaps.

The authors report the cumulative experience with freestyle perforator flaps of two medical centers (Hôpital Maisonneuve-Rosemont and University of Texas Southwestern Medical Center). Fifty-three pedicled perforator flaps were performed on 49 patients for local reconstruction of a range of defects at various anatomical locations: head and neck (n=3), anterior trunk (n=13), posterior trunk (n=9), perineal/gluteal (n=4), lower limb (n=20), and upper limb (n=4).

Complete flap survival was obtained in 48 of 53 flaps. Complications included three cases of partial flap necrosis and two total flap failures, the latter in high-risk patients. Complete primary closure of the donor site was possible in 37 cases, especially in the trunk. Twelve patients had partial primary closure complemented by skin grafting, three cases required complete skin grafting, and one donor site required another local flap for closure. Five clinical examples are given-anterior trunk, posterior trunk, cervical region, lower limb, and upper limb.

This is a large series on clinical applications of the freestyle pedicled perforator flap. Because of its many advantages and its versatility, the authors believe it will find its place as a valued reconstructive option and, when indicated, a simpler alternative to free flaps.