The Freestyle Facial Perforator Flap, a New Workhorse Local Flap?

Purpose

Since 2008 island perforator flaps are increasingly replacing the local pedicle flaps in our practice for the reconstruction of moderate size skin defects of the face.     We want to present our current method that is much simpelyfied from the initial method and emphasize some key steps in flap dissection and planning.    

Materials and Methods

Initially a careful dissection was carried out with loop magnification looking for a perforator in the previously planned local flap that subsequently was turned into an island flap based only on a perforator pedicle. Plan B was a full thickness skin graft.   A retrospective case series of 19 patients with moderate size oncologic skin defects were reconstructed in a single operation using 21 local island perforator flaps. 

Results

A sufficient perforator was located in every case and the flap rotated along its axis (76%)or advanced (24%).  Reconstruction was successfully achieved with a high self reported patient satisfaction. Two minor complications occurred early on in the series and a corrective procedure was performed in 4 patients.  No flap loss occurred and plan B was not necessary in any case.

Conclusions

The random facial perforator flap seems to be a good and reliable option for the reconstruction of facial subunits, especially the periorbital, nasal and periocular area with a minimal morbidity and a pleasing result in a one stage outpatient setting.