The Freestyle Multiperforator Island Flap: Beyond the Keystone Flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Introduces freestyle multiperforator island flaps as an advancement over keystone perforator flaps.
• These flaps utilize a free-design approach with multiple perforators in small, randomly located subcutaneous pedicles.
• Allows for customized flap designs to accommodate diverse anatomical complexities.

Purpose of the Study:

• To evaluate the safety, versatility, and outcomes of freestyle multiperforator island flaps.
• To assess the relationship between pedicle area size and flap necrosis.
• To determine the clinical efficacy in various anatomical locations and defect etiologies.

Main Methods:

• Retrospective cohort study of 150 patients undergoing flap reconstruction between 2012 and 2021.
• Involved 211 flaps for 184 defects, with a mean follow-up of 8.7 months.
• Chi-square test used to analyze the correlation between pedicle area and necrosis incidence.

Main Results:

• Most common etiologies were tumors (30.4%) and trauma (23.3%), predominantly in head/neck (31%) and lower limbs (30.4%).
• Complications occurred in 29.8% of flaps, with only 8.1% requiring reintervention; dehiscence (18.5%) and partial necrosis (9%) were most frequent.
• No statistically significant relationship was found between pedicle area size and necrosis (P = 0.813).

Conclusions:

• Freestyle multiperforator island flaps are a safe and versatile reconstructive tool.
• The technique yields excellent aesthetic results with low rates of necrosis and high cost-effectiveness.
• Offers a valuable alternative for complex coverage defects in various anatomical sites.