title: Freestyle pedicled perforator flaps: safety, prevention of complications, and management based on 85 consecutive cases.
abstract: BACKGROUND
  Despite the widespread use of free perforator flaps, pedicled perforator flaps seem not to be as widely accepted, probably because of the fear of vascular complications caused by transfer of a flap attached only by its vascular pedicle, prone to shearing, kinking, and trauma. In this article, the authors report on their experience with 85 consecutive cases, focusing on incidence, prevention, and management of complications.
  
  
  METHODS
  Eighty-five consecutive cases were treated over 6 years at the Plastic and Reconstructive Surgery Department of the University of Palermo for defects of different causes that were reconstructed with a freestyle pedicled perforator flap, in every region of the body, including the head and neck (41.2 percent), trunk (20 percent), upper limb (7.1 percent), and lower limb (31.8 percent). The majority of flaps (67.1 percent) were 180-degree propeller perforator flaps.
  
  
  RESULTS
  Complete flap survival was observed in 93 percent of cases. Six flaps (7 percent) had vascular complications that were managed with venous supercharging (two cases), derotation (one case), conservative management (two cases), or secondary skin grafting (one case). The authors provide their approach to each situation to prevent or manage complications.
  
  
  CONCLUSIONS
  The 93 percent success rate in this series seems to be acceptable and demonstrates that these flaps might be safely included in the authors' routine. If the flaps are appropriately planned and executed, with the suggestions provided in this article, some mistakes can be avoided to make these flaps even safer.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Palermo and Modena, Italy From Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, and Chirurgia Plastica e Ricostruttiva, Policlinico di Modena.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordova
authors.forename: Marco
authors.initials: M
authors.lastname: Pignatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Moschella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology