Expanded version pedicled free-style perforator flaps in clinical practice: a need for a more comprehensive classification system.

Background: The evolution of the angiosome concept into the perforasome theory as we increasingly move towards the distal end of the microvascular tree for reconstructive options has allowed us to design ad hoc perforator flaps.Methods: In a retrospective sample of more than 60 pedicled perforator flaps over a 36-month period, a variety of defects in all regions of the body were reconstructed. Pre-operative planning was based on either Doppler vascular studies or CT angiography.Results: The overall complete flap survival rate was 89%, with a tip necrosis rate of 8.1% and a partial flap necrosis rate of 3.3%. The risk factors identified were smoking, nicotine patches, vasopressor use and pro-thrombotic states.Conclusions: It is feasible to perform the many variations of perforator flaps provided; the microsurgical anatomy of the area is well defined, aided by imaging studies as necessary. Risk stratification also needs to be taken into account when planning these flaps. Based on our results and observations, an alternative pedicled perforator flap classification is put forward.Level of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]