Evaluation of the surgical technique and feasibility of freestyle pedicled perforator flaps for reconstruction, at different anatomical sites, after oncosurgical resection and identification of the required safety measures to avoid complications. BACKGROUND: The advancement of flap design coincided with the increased knowledge of skin vascular anatomy. Perforator flaps were first described by Koshima and Soeda. Taylor and Palmer described the angiosome, which is the vascular territory of each vessel and its perforators. Then, Saint-Cyr introduced the perforasome, which is the vascular territory of each perforator. Wei and Mardini improved the use of perforator flaps by describing freestyle free perforator flaps, where any cutaneous flap can be raised if at least one supplying perforator is preserved. They used a handheld Doppler to map the perforators. Finally, the freestyle technique was modified into a pedicled flap technique. PATIENTS AND METHODS: This study includes the experience acquired at the National Cancer Institute - Cairo University, over the past 5 years (2017-2021), using the freestyle pedicled perforator flaps, based on perforators identified using a handheld Doppler device, to reconstruct various anatomical regions of the body. RESULTS: The total number of cases was 24 patients and 27 flaps. The ages ranged from 22 to 81 years old. The size of the defects ranged from 2 to 300 cm². The head and neck regions were the most common sites of the defects, followed by the trunk, upper and lower extremities. The flaps were used to reconstruct defects after surgical resection of: 17 skin cancers, 6 soft tissue sarcomas, and 1 neck fistula after total laryngectomy. All flaps survived except for 2 complete losses. Other complications encountered were partial loss of 5 flaps and dehiscence of 3 flaps.

Freestyle; pedicled flaps; perforator; reconstruction