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European Journal of Plastic Surgery

, Volume 41, Issue 3, pp 345–350 | Cite as

Expanded version pedicled free-style perforator flaps in clinical practice: a need for a more comprehensive classification system

  • Ruben Y. Kannan
  • J. Hardwicke
Original Paper
  • 44 Downloads

Abstract

Background

The evolution of the angiosome concept into the perforasome theory as we increasingly move towards the distal end of the microvascular tree for reconstructive options has allowed us to design ad hoc perforator flaps.

Methods

In a retrospective sample of more than 60 pedicled perforator flaps over a 36-month period, a variety of defects in all regions of the body were reconstructed. Pre-operative planning was based on either Doppler vascular studies or CT angiography.

Results

The overall complete flap survival rate was 89%, with a tip necrosis rate of 8.1% and a partial flap necrosis rate of 3.3%. The risk factors identified were smoking, nicotine patches, vasopressor use and pro-thrombotic states.

Conclusions

It is feasible to perform the many variations of perforator flaps provided; the microsurgical anatomy of the area is well defined, aided by imaging studies as necessary. Risk stratification also needs to be taken into account when planning these flaps. Based on our results and observations, an alternative pedicled perforator flap classification is put forward.

Level of Evidence: Level IV, therapeutic study.

Keywords

Classification of perforator flaps Free-styled flaps Ad hoc flaps 

Notes

Compliance with ethical standards

Funding

None.

Conflict of interest

Ruben Yap Kannan, J. Hardwicke declare that they have no conflict of interest.

Ethical approval

For this kind of retrospective study formal consent from a local ethics committee is not required.

Informed consent

Patient provided written consent before their inclusion in this study.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Plastic SurgeryQueen Victoria HospitalEast GrinsteadUK
  2. 2.Department of Plastic SurgeryUniversity Hospitals Coventry and WarwickshireCoventryUK

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