Local Free-Style Perforator Flaps in Head and Neck Reconstruction: An Update and a Useful Classification

Any standard skin flap of the body including a detectable or identified perforator at its axis can be safely designed and harvested in a free-style fashion.

Fifty-six local free-style perforator flaps in the head and neck region, 33 primary and 23 recycle flaps, were performed in 53 patients. The authors introduced the term "recycle" to describe a perforator flap harvested within the borders of a previously transferred flap. A Doppler device was routinely used preoperatively for locating perforators in the area adjacent to a given defect. The final flap design and degree of mobilization were decided intraoperatively, depending on the location of the most suitable perforator and the ability to achieve primary closure of the donor site. Based on clinical experience, the authors suggest a useful classification of local free-style perforator flaps.

All primary and 20 of 23 recycle free-style perforator flaps survived completely, providing tension-free coverage and a pleasing final contour for patients. In the remaining three recycle cases, the skeletonization of the pedicle resulted in pedicle damage, because of surrounding postradiotherapy scarring and flap failure. All donor sites except one were closed primarily, and all of them healed without any complications.

The free-style concept has significantly increased the potential and versatility of the standard local and recycled head and neck flap alternatives for moderate to large defects, providing a more robust, custom-made, tissue-sparing, and cosmetically superior outcome in a one-stage procedure, with minimal donor-site morbidity.

Therapeutic, V.