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Freestyle Multiperforator Island Flap for Reconstruction of Extensive Thoracoabdominal Defects: A Case Report.
Frank Andrés Álvarez Vásquez1, Yasser Farid2, Iván Enrique Rodríguez Mantilla3
1Department of Plastic Surgery, Clínica Los Nogales, Physician, School of Medicine, Universidad del Rosario, Bogotá, Colombia.
Annals of Plastic Surgery
|April 9, 2026
Summary
The Freestyle Multiperforator Island Flap (FMIF) offers a reliable solution for extensive thoracoabdominal defects, providing durable coverage and preserving function. This perforator-based flap is an efficient alternative to free-flap reconstruction.
Area of Science:
- Plastic Surgery
- Surgical Oncology
- Reconstructive Surgery
Background:
- Extensive thoracoabdominal defects present significant reconstructive challenges, especially over prosthetic materials.
- Conventional flaps face limitations like donor-site morbidity and operative complexity.
Purpose of the Study:
- To describe the use of a Freestyle Multiperforator Island Flap (FMIF) for large thoracoabdominal defect reconstruction.
- To evaluate the efficacy of FMIF in cases where free-flap reconstruction is not feasible.
Main Methods:
- Reconstruction of a large thoracoabdominal defect using an FMIF based on deep inferior epigastric artery perforators.
- Flap designed with a reduced pedicular area for direct advancement, utilizing intraoperatively identified perforators.
- Free autologous reconstruction with a deep inferior epigastric artery perforator (DIEP) flap was not feasible due to insufficient abdominal tissue.
Main Results:
- The FMIF achieved immediate, stable, and well-vascularized coverage of the defect, including prosthetic mesh and osteosynthesis.
- Complete flap survival and no perioperative complications were observed.
- At 12-month follow-up, durable coverage, satisfactory contour, and preserved function were maintained.
Conclusions:
- FMIF with a reduced pedicular area is a reliable and efficient reconstructive option for extensive thoracoabdominal defects.
- This technique expands the utility of perforator-based local flaps.
- It serves as a valuable alternative to free-flap reconstruction, optimizing operative efficiency.
