Technical tips in perforator flap harvest Naci Celik, MD a , Fu-Chan Wei, MD, FACS b, * a ONEP Plastic Surgery Science Institute, Manolyali Sokak No: 33, Levent 80620, Istanbul, Turkey b Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan With the recent development of the perforator flap, several musculocutaneous flaps have been replaced by their perforator counterparts. The major reasons for selecting this type of flap is the reduced morbidity of the donor site with preservation of the nerves, muscles, and deep fascia and its suitable thickness for resur- facing [1]. In an experienced microsurgeon’s hand the supermicrosurgery technique with anastomosis of 0.5 mm caliber vessels at the suprafascial level makes this kind of flap even more versatile by preserving the major vessels [2]. The anterolateral thigh flap [3 – 6], deep inferior epigastric artery flap [7–9], superior gluteal artery flap [10], tensor fascia latae flap [11], la- tissimus dorsi flap [1,12], paraumblical flap [13 – 15], deep circumflex iliac flap [16], and medial plantar flap [2] are among the flaps that can be based on the perforating vessels. The perforator counterpart of the peroneal flap, the lateral leg perforator flap, had been used to resurface postburn anterior cervical contracture in a patient who had little choice of free flaps, because of near total burn of the anterior and posterior surface of the body [17]. This is an interesting case to show the versatility of the perforator flaps which can be planned as ‘‘freestyle free flaps’’ [18]. They give freedom to the surgeon because they may be planned in any part of the body and in any shape. The elevation of a perforator- based flap necessitates the proper planning of the shape of the flap, to include the perforator vessels and scrupulous intramuscular dissection of those tiny vessels [4]. The article provides technical and strategic advice to less experienced microsurgeons who are concerned with this kind of operation. A retrospective study A retrospective study was performed at Chang Gung Memorial Hospital in 2001. From June 1996 to August 2000, a total of 672 free anterolateral thigh flaps were performed on 660 patients. A total of 439 flaps that were identified as cutaneous or fascio- cutaneous, on the basis of musculocutaneous perfo- rators, were included in this study (87.1% of all cutaneous or fasciocutaneous anterolateral thigh flaps). Anterolateral thigh flaps that were based on septocutaneous vessels, or elevated as a musculocu- taneous flap or chimeric flap, were excluded. There were 375 male and 64 female patients, who ranged in age from 11 to 94 years (average: 54.6 years). Results Overall, the success rate in the perforator flap series was 96.6% (424 of 439 flaps). Of the 15 fail- ures, eight were complete and seven were partial (10% to 60% flap loss). A total of 34 flaps (7.74%) were re-explored. All re-explorations were performed in the first 24 hours from the end of the first re- circulation of the flap. Nineteen of the 34 flaps (55.9%) were salvaged totally after the exploration. In this series of 672 anterolateral thigh flaps, there was no suitable perforator or fasciocutaneous vessel for dissection in six cases (0.89%). In three of these 0094-1298/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S0094-1298(03)00042-7 * Corresponding author. E-mail address: fcw2007@adm.cgmh.org.tw(F.-C. Wei). Clin Plastic Surg 30 (2003) 469 – 472