Perforator chimerism for the reconstruction of complex defects: A new chimeric free flap classification system

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Complex defects pose significant challenges for reconstructive surgeons.
• Chimeric flaps offer advantages over traditional methods like free flaps or staged reconstruction, including fewer procedures and reduced donor site morbidity.
• The perforator flap concept has advanced the versatility and design of chimeric flaps.

Purpose of the Study:

• To discuss perforator-based chimeric flaps.
• To introduce a novel, practice-based classification system for chimeric flaps, termed "Perforator Chimerism."
• To aid reconstructive surgeons and trainees in understanding and applying chimeric flap design.

Main Methods:

• Analysis of chimeric flap patterns in 31 consecutive cases.
• Development of a new classification system based on the perforator flap concept.
• Illustrative case series presentation.

Main Results:

• Chimeric flaps, incorporating the perforator concept, enable safe, effective, and aesthetically superior reconstruction of complex defects.
• A four-type classification system (Type I: Classical, Type II: Anastomotic, Type III: Perforator, Type IV: Mixed Chimerism) was proposed.
• Type III (Perforator Chimerism) utilizes the perforator concept without requiring microvascular anastomosis between tissue components.

Conclusions:

• The perforator concept enhances chimeric flap design for complex defect reconstruction.
• The "Perforator Chimerism" classification system provides a structured approach for understanding and implementing these flaps.
• This classification facilitates the integration of advanced chimeric flap techniques into surgical practice.