Pre-expanded Free Perforator Flaps

Pre-expanded perforator flaps are the most recent technical way to shape tissue for exact needs. Reconstruction with pre-expanded free perforator flaps has proven successful in terms of obtaining more extensive, more pliable, and thinner flaps that have increased vascularity, and also causing less donor site morbidity. In this article the author’s experience with the clinical application of such flaps and the relevant published literature are reviewed.

Key points

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All preoperative planning activities (perforator designation, perforator and source vessel tracing, and detection of neighboring perforators) should be executed on the patient in the same position as they will be lying during the flap harvest procedure.
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Exposure of the designated perforator should be avoided during the expander implantation session.
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At each inflation session, a smaller volume of saline compared with a conventional tissue expansion is administered, which causes minimal lengthening in the overall expansion period.
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Dissection of the nonexpanded side first allows the surgeon to approach the perforator through untouched tissues such that this part of the procedure becomes less complex, almost the same as a conventional perforator flap dissection.