The freestyle pedicle perforator flap: a new favorite for the reconstruction of moderate-sized defects of the torso and extremities.

Gudjon Leifur Gunnarsson,Ian T Jackson,Tormod S Westvik,Jorn Bo Thomsen

doi:10.1007/s00238-014-1043-4

Gudjon Leifur Gunnarsson, Ian T Jackson + Show 2 more

Open Access

https://doi.org/10.1007/s00238-014-1043-4

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Abstract

BackgroundPerforating vessels are a consistent anatomical finding and well described in the current literature. Any skin flap can be raised on a subcutaneous pedicle as long as it contains at least one supplying perforator. Perforator flaps have been interlinked with microsurgery and generally not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso.MethodsWe retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled perforator flaps for moderate-sized defects of the truncus and extremities. We registered indications, flap size and localization, success rate, and complications. Most importantly, we describe a simple approach to the design of freestyle pedicled perforator flaps and elaborate on technical aspects in the context of current literature.ResultsThe reconstructive goals were achieved in all cases without any total flap loss or major complications. Minor complications occurred in 7/34 (21 %) cases consisting of venous congestion leading to distal tip necrosis or epidermolysis; partial flap loss was significant in 4 cases, however never more than 10 % of the total flap size. Reconstruction was performed on the lower limb in 13 cases, upper limb in 12, and 9 cases were on the truncus. The angle of rotation was 90° in 21 cases and 180° in 13 cases. The most common indication was reconstruction of oncological skin defects; melanoma 19, BCC 6, SCC 2, other 7. The flap size varied from 1.5×3 cm to 12×22 cm. The perforator identification was done by intraoperative exploration in 17 cases and by color Doppler ultrasonography in 17 cases.ConclusionsModerate-sized defects of the torso and extremities can be successfully reconstructed by pedicled perforator flaps. The flap dissection is simple, and the complication rates comparable to other reconstructive options.Level of evidence IV, therapeutic study

Highlights

The evolution of modern flap surgery and microsurgery is interlinked with the understanding of skin flap anatomy and clinical observations
The freestyle flap concept was first introduced in 1983 by the Finnish surgeon Asko-Seljavaara [9]. It refers to the wide array of perforators that can safely supply a skin flap within the given perforasome [7]
The perforator located nearest to the defect allows for the shortest angle of rotation and simplest flap design

Summary

Introduction

The evolution of modern flap surgery and microsurgery is interlinked with the understanding of skin flap anatomy and clinical observations. Ian Taylor and associates have shown that skin vascularity is known to be supplied by perforators in a persistent anatomical pattern that applies directly to their use in flap surgery [5]. The angiosome originally described by Taylor and Palmer [6] in 1987 has been further narrowed down to a perforasome to explain the reliable area of skin supplied by a single perforator [7]. Any skin flap can be raised on a subcutaneous pedicle as long as it contains at least one supplying perforator. Perforator flaps have been interlinked with microsurgery and generally not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso

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