Gómez Oswaldo J, Espinel Pinzón Daniel Alejandro, Duque David F, Moreno Harold D, Beltrán Pachón Paloma
From the Plastic Surgery Unit, Universidad Nacional de Colombia, Bogotá, Colombia.
Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
Plast Reconstr Surg Glob Open. 2025 Feb 10;13(2):e6503. doi: 10.1097/GOX.0000000000006503. eCollection 2025 Feb.
This study aimed to introduce freestyle multiperforator island flaps as a technical advancement beyond keystone perforator flaps. These flaps represent a fully free-design approach, supplied by multiperforators in small subcutaneous pedicles randomly located, allowing for customized designs tailored to anatomical regions of diverse complexity.
We present a retrospective cohort study of 150 patients with coverage defects, without distinction of anatomical location or age, treated between 2012 and 2021. The study assessed the clinical presentation, flap characteristics, additional procedures, and postoperative outcomes. We used the chi-square test to assess the relationship between pedicle area size and the incidence of partial or complete necrosis.
We performed 211 flaps on 184 defects, with a mean follow-up of 8.7 months. Tumors (30.4%) and trauma (23.3%) were the most common etiologies. Most flaps were performed on the head and neck (31%) and lower limbs (30.4%). The mean pedicle area was 33%, and the flap-to-defect size ratio was between 1:1 and 3:1 in 82% of cases. Complications occurred in 29.8% of the flaps, with only 8.1% needing surgical reintervention. The most common occurrences were dehiscence (18.5%), partial necrosis (9%), and total necrosis (1.9%). The pedicle area of the flap did not demonstrate a statistically significant relationship with the necrosis outcome ( = 0.813; 95% confidence interval, 0.17-0.926).
Freestyle multiperforator island flaps are a safe and versatile tool with low necrosis rates, excellent aesthetic results, and unmatched cost-effectiveness.
本研究旨在引入自由式多穿支岛状皮瓣，作为对关键穿支皮瓣技术的进一步发展。这些皮瓣采用完全自由设计，由随机分布于皮下小蒂部的多个穿支供血，可针对不同复杂程度的解剖区域进行定制设计。
我们对2012年至2021年间治疗的150例覆盖缺损患者进行了一项回顾性队列研究，患者不限解剖位置和年龄。该研究评估了临床表现、皮瓣特征、附加手术及术后结果。我们使用卡方检验来评估蒂部面积大小与部分或完全坏死发生率之间的关系。
我们对184处缺损实施了211例皮瓣手术，平均随访8.7个月。肿瘤（30.4%）和创伤（23.3%）是最常见的病因。大多数皮瓣手术在头颈部（31%）和下肢（30.4%）进行。平均蒂部面积为33%，82%的病例中皮瓣与缺损大小之比在1:1至3:1之间。29.8%的皮瓣出现并发症，仅8.1%需要再次手术干预。最常见的情况是裂开（18.5%）、部分坏死（9%）和完全坏死（1.9%）。皮瓣的蒂部面积与坏死结果之间未显示出统计学上的显著关系（ = 0.813；95%置信区间，0.17 - 0.926）。
自由式多穿支岛状皮瓣是一种安全且通用的工具，坏死率低，美学效果极佳，性价比无与伦比。
