Perforator plus flaps: Optimizing results while preserving function and esthesis.

Area of Science:

• Reconstructive Surgery
• Plastic Surgery
• Microsurgery

Background:

• Traditional flaps often result in collateral damage to functional muscle, vessels, or nerves.
• The perforator plus flap concept utilizes dual vascular supply to enhance flap viability.
• This technique aims to preserve nerves, vessels, and muscle function, improving outcomes.

Purpose of the Study:

• To evaluate the application and outcomes of the perforator plus flap technique in diverse clinical scenarios.
• To assess the efficacy of perforator plus flaps in providing stable wound cover while minimizing functional and aesthetic deficits.

Main Methods:

• The perforator plus concept was applied to seven patients with various defects, including lower extremity and back injuries.
• Functional muscle, fasciocutaneous, and adipofascial flaps were utilized.
• Specific cases included coverage for tibial fractures and chronic venous ulcers.

Main Results:

• All perforator plus flaps achieved successful survival and provided long-term stable coverage over soft tissue and bone.
• Functional preservation was noted in all muscle flap cases, with no loss of power.
• Neurovascular preservation resulted in no sensory loss or significant edema; fracture union was satisfactory.

Conclusions:

• The perforator plus concept is a versatile and holistic approach applicable to various flap types and clinical situations.
• This technique effectively limits collateral functional damage and addresses aesthetic considerations, particularly with adipofascial flaps.
• Perforator plus flaps represent a superior alternative to traditional flaps and free tissue transfers due to quick operating times and low failure rates.