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Updated: May 11, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Free-style perforator flaps in the reconstruction of the lower limb
Simona Rinaldi1, Alessandro Piperno, Marco Toscani
1Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome Sapienza, Policlinico Umberto I, 00141 Rome, Italy
Introduction:
The evolving concept of free-style flaps with one or more perforators able to lend support, has been shown to have noteworthy advantages in the context of reconstructive surgery, especially in relation to the distal portion of the lower limb. Among the advantages, an analogy of the covering tissues with pre-existing ones in the compromised area, reduced morbidity of the donor site, less time spent in theatre and a greater flexibility from the surgeons' point of view.
Material And Methods:
Between 2009 and 2012, 18 patients were treated with local free-style flaps for lesions involving the leg and the foot. The median age of the patients, (11 men and 7 women) was 63.2 years. Subsequently, the patients were followed up for 6 months-1 year.
Results:
In the period following surgery all the free style flaps have survived completely; further surgery has not been warranted. Healing of the donor sites took place by primary intention in 17 cases; in one case, a V-Y advancement flap adapted as a cover for a loss of substance of the calcaneus, it occurred by secondary intention.
Discussion And Conclusions:
Lower limb reconstruction, in virtue of the fact that adjacent tissues for reconstruction are scarce and vascularization is an issue, has always constituted a problem which has not been easy to solve for the surgeon. The application of the free-style concept to loco-regional flaps has yielded satisfactory results in our experience, from both a functional as well as an aesthetic point of view.
