• free flap.
• microsurgery
• perforasome
• perforator flap
• plastic surgery

The paramount principles of perforator flaps and perforasome had already been described through thoroughly conducted cadaveric studies. However, some questions remain unanswered. Most importantly, the amount of tissue being vascularized by a single perforator still needs to be defined as long as the importance of perforator diameter and distance of perforator from flap edges. The lack of vascular knowledge may explain partial necrosis rates, which can be as high as 11.3% after reconstruction with perforator flaps.
In the present clinical study, we aimed at focus on filling the gap between a correctly planned perforator flap and the surgical outcomes that could be sometimes disappointing. To the best of our knowledge, this is the first clinical study that investigates the pertinent role of perforator caliber, distance of the perforator from flap edge, and whether the number of suitable perforators of a perforator flap has a key role in flap viability.
Between December 2018 and February 2021, patients presenting at our Institution and in need for a soft tissue or combined soft and bony tissue reconstruction due to oncologic or traumatic reasons were assessed. Thirty-three patients meeting the inclusion criteria were enrolled. Four patients were excluded intraoperatively and three patients were lost to follow-up. A total of 26 oncologic patients were finally evaluated. Data of all the surgeries were prospectively collected in a digital database accounting for demographics and surgical characteristics, medical history, complications and outcomes. During every surgical operation, several parameters were measured including flap size, perforator caliber (right after irrigation with warm saline) and number of reliable perforators divided during the procedure; the position of the selected perforator was noted both preoperatively and intraoperatively. Both in case of a free or pedicled perforator flap, the perforating vessel was selected through preoperative imaging, and the choice was confirmed with doppler examination.