الفهرس 
Title : Freestyle perforator flap for reconstruction after oncosurgical resection
AbstractOnly 14 pages are availabe for public view
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Abstract
Evaluation of the surgical technique and feasibility of
freestyle pedicled perforator flaps for reconstruction, at different anatomical sites, after
oncosurgical resection and identification of the required safety measures to avoid complications.
BACKGROUND: The advancement of flap design coincided with the increased knowledge of
skin vascular anatomy. Perforator flaps were first described by Koshima and Soeda. Taylor and
Palmer described the angiosome, which is the vascular territory of each vessel and its
perforators. Then, Saint-Cyr introduced the perforasome, which is the vascular territory of each
perforator. Wei and Mardini improved the use of perforator flaps by describing freestyle free
perforator flaps, where any cutaneous flap can be raised if at least one supplying perforator is
preserved. They used a handheld Doppler to map the perforators. Finally, the freestyle technique
was modified into a pedicled flap technique.
PATIENTS AND METHODS: This study includes the experience acquired at the National
Cancer Institute - Cairo University, over the past 5 years (2017-2021), using the freestyle
pedicled perforator flaps, based on perforators identified using a handheld Doppler device, to
reconstruct various anatomical regions of the body.
RESULTS: The total number of cases was 24 patients and 27 flaps. The ages ranged from 22 to
81 years old. The size of the defects ranged from 2 to 300 cm². The head and neck regions were
the most common sites of the defects, followed by the trunk, upper and lower extremities. The
flaps were used to reconstruct defects after surgical resection of: 17 skin cancers, 6 soft tissue
sarcomas, and 1 neck fistula after total laryngectomy. All flaps survived except for 2 complete
losses. Other complications encountered were partial loss of 5 flaps and dehiscence of 3 flaps.
CONCLUSION: Freestyle pedicled perforator flaps are a reliable option for the reconstruction of
non-composite defects when a sizable perforator is localized and the flap is designed according
to the blood flow of the linking vessels. These flaps ensure promising functional and aesthetic
results. It is not a time-consuming technique with a low complication rate. Moreover, the
feasibility of mapping perforators using a handheld Doppler caused a vast spread of the
procedure as a simple technique with favorable results.