Assessment of Local Freestyle Perforator Flaps for Face Defects Reconstruction

Background: Freestyle perforator-flap surgery allows for more versatility in selecting a donor location by basing flap selection on the specific quality and quantity of soft tissue needed at the recipient site.
Objective: The aim of the current work was to evaluate the role of freestyle perforator flaps in reconstruction of small to medium-sized facial defects in plastic and reconstructive surgery.
Subjects and methods: This interventional study included a total of 18 patients with small to medium-sized facial defects reconstructed with freestyle local perforator flaps, attending at Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Zagazig University Hospitals. Preoperative perforator detection and its markings was done by hand-held Doppler and was confirmed by intraoperative exploration before raising a suitable flap. Patients were followed up 6 months or more postoperatively after discharge from the hospital.
Results: Postoperative histopathology indicated that all the margins of the resected tissue were free of cancerous cells. Most cases had defects on the nose (33.3%), cheek (22.2%) and Lower lip (11.1%). 6 Flaps were based on facial artery perforators to cover nasal, cheek, and upper lip defects. 2 flaps were based on infraorbital artery perforators. Also, Superficial temporal artery and supra-trochlear artery represented a good donor of perforator flaps in our work. Congestion occurred in 4 patients. In only two patients, flaps showed ischemia. Regarding patient satisfaction with the aesthetic result, 6 of them were excellent, 6 were good, four were fair and two were poor.
Conclusion: Because of their adaptability, wide range of motion, similar texture, and color match, the freestyle local perforator flaps could be used successfully to rebuild complex face deformities for cosmetic purposes.