Secondary extremity reconstruction with free perforator flaps for aesthetic purposes

Perforator flap surgery enables surgeons to tailor flaps to individual requirements with reduced donor-site morbidity. The technique allows better aesthetic results to be achieved in various fields of microsurgical reconstruction, but reports on aesthetic resurfacing and contour restoration of extremity deformities are sparse. The authors present their experience of elective reconstructions of established deformities in the extremities for aesthetic purposes using free perforator flaps. Aesthetic results were evaluated using a questionnaire and by photographic grading. From March 2006 to June 2010, 15 free flaps were transferred in 14 patients for aesthetic purposes to restore established skin and soft-tissue deformities in the extremities. Twelve flaps were transferred to lower extremities and three to upper extremities. After recreating tissue deficiencies, flaps were precisely designed and elevated with elaborate flap insetting and thickness control. Patient-assessment questionnaires were administered after surgery, and aesthetic results were evaluated using photographs by independent observers. Photographic gradings were assessed statistically using the generalised estimating equation. Eight deep inferior epigastric artery perforator free flaps and seven thoracodorsal artery perforator free flaps were used in the 14 patients. Flap sizes ranged from 8 × 14 to 14 × 38 cm, and all flaps survived well. The patient satisfaction rate was high, and aesthetic improvements were confirmed by conducting objective photographic evaluations. Statistically significant changes were detected during the photographic evaluation (p < 0.05). Secondary reconstruction using a customised free perforator flap to achieve aesthetic improvements is a valuable option for the restoration of established skin and soft-tissue deformities in the extremities.