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The concept of the special form perforator flap and its role in the evolution of reconstruction

Background: Reconstruction of complex soft tissue defects remains a challenging problem for microsurgery and plastic surgeons. Perforator flaps have become one of most popular option for extremity defect reconstruction in the past two decades due to minimized donor site morbidity and aesthetically contour. Special form perforator flap is the derivative of the perforators flap, and further expands its indications. In this article, we present our experience on using the optimal design of perforator flap for customized reconstruction of complex soft tissue defects of the extremities. Methods: We retrospectively reviewed data from patient who underwent reconstruction of soft tissue defects of the extremities using individual design of perforator flaps between January 2008 and November 2018. We performed the optimal design of perforator flap through graphic design, hierarchy structure and carrying tissue based on characterization of the soft tissue defect. Results: Various types of perforator flaps including flow-through perforator flap, chimeric perforator flap, conjoined perforator flap, micro-dissected perforator flap and multi-lobed perforator flap were performed for the reconstruction of complex soft tissue defect. Those types of flaps also can be adopted for especially difficult extremity reconstruction by combining with each other. 
 Conclusions: Our ten years experiences show that the optimal design of perforator flaps provides more aesthetically contours and minimizes donor site morbidity. It further expends the range of application and indication of perforator flap.