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Pedicled Free-Style Perforator Flaps for Trunk Reconstruction: A Reliable Method

Background: By exploring the perforating vessels that supply the soft tissues adjacent to a given defect, a perforator flap can be designed in free-style fashion. Methods: From 2009 to 2013, 14 defects of the trunk (excluding the abdomen) were reconstructed using pedicle free-style perforator flaps at the Department of Plastic Surgery, E-Da Hospital, Taiwan. Several perforators at the periphery of the defect were detected and marked preoperatively using a handheld Doppler probe. Then, they were explored intraoperatively through the existing wound edge after wide excision of lesions. The most suitable perforator was selected by means of direct vision and chosen as the pivot point, and then the flap was designed around it, taking into consideration the axiality of the vessel and the ability to achieve direct donor-site closure. Results: All of the flaps survived completely, except for one flap that partially failed because of congestion, and for which the salvage procedure was a skin graft. Full coverage of the defect with excellent contour and color matching and primary closure of the donor sites was achieved in all of the patients. Conclusions: The free-style approach to trunk reconstruction allows the surgeon to complete a robust like-for-like reconstruction while confining the scar burden to a single site. Using the handheld Doppler device and visualizing the perforators directly through the wound edge eliminates the need for preoperative imaging, and allows for the optimal flap to be designed based on vessel size and quality and minimizes donor-site morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.