, Shimin Chang2, Jian Lin3 and Dajiang Song1
(1)
Department of Orthopedic Surgery, Changzheng Hospital Second Military Medical University, Shanghai, China
(2)
Department of Orthopedic Surgery, Yangpu Hospital Tongji University School of Medicine, Shanghai, China
(3)
Department of Microsurgery, Xinhu Hospital Shanghai Jiao Tong University, Shanghai, China
In a selected donor site, raising a perforator flap entails: (1) localization of skin perforators using the handheld Doppler and (2) raising the flap by performing retrograde dissection from the perforator to the source vessel until a sufficient pedicle length and size has been achieved, regardless of the origin of the harvested vessel. This manner of flap elevation was firstly introduced by Wei and coauthors in 2004 and termed as free-style concept [1]. As a result of this concept, any skin paddle based on a substantially sized perforator, localized by an audible Doppler signal, can be potentially harvested. With a substantial number of available perforators in the body, this approach certainly increases the surgeon’s degree of freedom in terms of reconstructive options [2].
3.1 Surgical Technique
1.
The first step in performing a free-style perforator flap is locating sizable perforators in the selected region of the body. Handheld Doppler ultrasonography has been shown to be an accurate method of locating and mapping these cutaneous vessels. The operator carefully notes the quality of the Doppler sound detected with particular attention given to the location of loud, high-pitched, and pulsatile signals. The vessels with more prominent sounds are marked with a larger dot and selected as the vessel that is intended to dissect. The flap is then designed centered on these perforators.
2.
Dissection is performed under loupe magnification (2.5–3.5×). Only one border of the proposed design should be incised initially for exploration. This affords the flexibility to alter the flap design should this be necessary based on intraoperative findings.
