Free-style local perforator flaps: versatility of the v-y design to reconstruct soft-tissue defects in the skin cancer population

BACKGROUND: Freestyle local perforator flaps can be harvested from any region of the body where an appropriate and detectable perforator vessel is present. Their use allows the surgeon to perform a “like with like” reconstruction by mobilizing surrounding tissues on a consistent vascular source. The authors report their experience with V-Y free style perforator flaps in reconstruction of soft tissues defects consequent to skin cancer excision.METHODS: 40 elective defects in different regions of the body were reconstructed with V-Y advancement local perforator flaps raised in a free-style fashion. Sexual distribution was: 23 male patients, 17 female patients. Mean age at surgery was 63 years. All defects resulted from skin cancer ablation. Mean defect size was 5 x 3.7 cm. Mean flap dimensions were 8.8 x 4.2 cm. The flaps were based on one (10), two (18) or three (12) perforators.RESULTS: Mean operative time was 93 minutes. 37 flaps (92.5%) healed uneventfully. In 3 flaps (7.5%) moderate venous insufficiency occurred, leading to partial flap necrosis that required surgical revision. In 3 cases (7.5%) the flap was converted to a rotation/hatchet perforator based peninsular flap. Slight venous stasis was the most common postoperative finding registered (8 flaps, 20%). All flaps achieved adequate and durable reconstruction with excellent contour, with a follow up ranging between 6 months and 2 years. CONCLUSIONS: Free style local perforator flaps advanced in V-Y fashion proved to be a valid and reliable solution to restore function and aesthetics of the operated site after skin cancer excision.