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Free-Style Local Perforator Flaps: Versatility of the V-Y Design to Reconstruct Soft-Tissue Defects in the Skin Cancer Population

Brunetti, Beniamino M.D.; Tenna, Stefania M.D., Ph.D.; Aveta, Achille M.D.; Segreto, Francesco M.D.; Persichetti, Paolo M.D., Ph.D.

Plastic & Reconstructive Surgery: August 2013 - Volume 132 - Issue 2 - p 451–460
doi: 10.1097/PRS.0b013e3182958897
Reconstructive: Trunk: Original Articles

Background: Free-style local perforator flaps can be harvested from any region of the body where an appropriate and detectable perforator vessel is present. Their use allows the surgeon to perform a “like with like” reconstruction by mobilizing surrounding tissues on a consistent vascular source. The authors report their experience with V-Y free-style perforator flaps in reconstruction of soft-tissue defects subsequent to skin cancer excision.

Methods: Forty elective defects in different regions of the body were reconstructed with V-Y advancement local perforator flaps raised in a free-style fashion. There were 23 male patients and 17 female patients. Mean age at surgery was 63 years. All defects resulted from skin cancer ablation. Mean defect size was 5 × 3.7 cm. Mean flap dimensions were 8.8 × 4.2 cm. The flaps were based on one (n = 10), two (n = 18), or three (n = 12) perforators.

Results: Mean operative time was 93 minutes. Thirty-seven flaps (92.5 percent) healed uneventfully. In three flaps (7.5 percent), moderate venous insufficiency occurred, leading to partial flap necrosis that required surgical revision. In three cases (7.5 percent), the flap was converted to a rotation/hatchet perforator-based peninsular flap. Slight venous stasis was the most common postoperative finding registered (eight flaps; 20 percent). All flaps achieved adequate and durable reconstruction with excellent contour, with a follow-up ranging between 6 months and 2 years.

Conclusion: Free-style local perforator flaps advanced in V-Y fashion proved to be a valid and reliable solution to restore function and aesthetics of the operated site after skin cancer excision.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Rome, Italy

From the Plastic, Reconstructive, and Aesthetic Surgery Unit, Campus Bio-Medico of Rome University.

Received for publication November 22, 2012; accepted February 26, 2013.

Disclosure: No extramural funding was received for this work. The authors do not have any financial interest or commercial association with subject matter and/or products mentioned in the article.

Beniamino Brunetti, M.D., Plastic, Reconstructive, and Aesthetic Surgery Unit, Campus Bio-Medico of Rome University, Via Alvaro del Portillo, 200, 00128 Rome, Italy, b.brunetti@unicampus.it

©2013American Society of Plastic Surgeons