Advancing Pure Skin Perforator Flap Application: Microscope-Free Harvesting, Versatile Donor Sites, and Clinical...

Reconstruction of shallow but complicated defects with exposed critical structures often requires vascularized tissue with skin-like thinness, which pure skin perforator (PSP) flaps can provide. Despite their benefits, PSP flaps are underutilized due to uncertainties surrounding their application. This study reviews the authors' experience with free PSP flap reconstruction, focusing on the elevation process, donor-site selection, and clinical outcomes.

Patients who underwent microsurgical reconstruction using PSP flaps between April of 2021 and January of 2024 were reviewed. All flaps were elevated using loupe magnification through distal-to-proximal dissection. Donor sites were selected on the basis of the defect: superficial circumflex iliac perforator (SCIP) flaps for finger or toe defects and anterolateral thigh or thoracodorsal artery perforator (TDAP) flaps for longer pedicles. Development of complications and associated risk factors was investigated.

Seventy-one patients were analyzed, with a mean body mass index of 24.2 kg/m², including 55 SCIP, 10 anterolateral thigh, and 6 TDAP flaps. No conversions to microscope-assisted elevation were needed. The mean skin paddle size was 26.3 cm² with a thickness of 3.5 mm; TDAP flaps were thickest and SCIP flaps were thinnest. The average pedicle length was 4.8 cm, with TDAP flaps being the longest. Flap elevation took 37.0 minutes on average, which was consistent across flap types. Flap complications occurred in 18 cases, including 2 total flap losses and 4 partial losses, associated with chronic wounds and larger flap sizes.

PSP flaps might be a valuable reconstructive option for shallow but complicated defects, offering easy, microscope-free harvesting; versatile donor selection; and reliable outcomes.