Freestyle local perforator flaps for facial reconstruction: clinical experience and complications

Reconstruction of facial defects always represents a surgical challenge as functional and cosmetic outcomes must be taken into account more than any region of the body. The concept of freestyle perforator flaps has been developed to obtain a complete range of freedom in their movement to reach the defect. We present our clinical experience with facial perforator flaps, focusing on indications, surgical technique, and complications. Methods: Thirty-one facial defects were reconstructed with freestyle local perforator flaps between January 2007 and November 2014. Doppler identification of perforator vessels preceded preoperative planning and the flap harvesting followed the dissection of perforator vessels. Results: Twenty-two clinical cases had no complications. Four had venous congestion that resolved spontaneously, three had a distal 1/3 superficial necrosis, one suffered hematoma, and one had a 1/5 distal area of full thickness necrosis. Conclusions: Freestyle perforator approach was applied to gain more freedom for facial reconstruction, allowing one-stage procedures and low donor site morbidity. Good anatomical understanding, precise planning, and meticulous technique can affect clinical results of perforator flaps in the face. A critical approach is essential to get better results.