title: Partial failure of a perforator free flap can be salvaged by a second perforator free flap.
abstract: BACKGROUND
  Perforator flaps as an innovative method for soft tissue transfer that maximizes function preservation, were originally introduced primarily as free flaps. Their reliability and versatility has been found to not differ from other sources of free flaps where total failure is an uncommon event. Partial failure should also be recognized as a possible dilemma that is perhaps more of a unique untoward sequela of perforator flaps.
  
  
  METHODS
  A retrospective review of our flap experience over the past decade included 310 perforator free flaps. Partial perforator flap failure that required a second free flap for salvage was selected in 6 patients.
  
  
  RESULTS
  All perforator free flaps in our experience that had some form of partial failure were anterolateral thigh [ALT] free flaps. Clinically initially unrecognizable but ultimately distal flap ischemia could be attributed to poor flap design, and was the cause of immediate partial flap necrosis in 2 cases. Delayed difficulties were complications not specific to perforator flaps. In all cases, a free flap was considered the best option, and a second perforator free flap proved to resolve all reconstructive objectives.
  
  
  CONCLUSIONS
  The root cause of partial failure of a perforator free flap was found to be either iatrogenic or de novo in origin. The proper design requires an awareness of the correct topographic axis and an understanding of the perforasome concept to better insure adequate flap perfusion. If a free flap is still considered the best solution after a partial failure, the advantages and benefit of a second perforator free flap should not be overlooked.
authors.affiliation: Division of Plastic Surgery, Sacred Heart and The Lehigh Valley Hospitals, Allentown, Pennsylvania, St. Luke's Hospital, Bethlehem, PA.
authors.forename: Geoffrey G
authors.initials: GG
authors.lastname: Hallock
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005360:Fibula / Q000293:injuries; D050723:Fractures, Bone / Q000601:surgery; D058752:Free Tissue Flaps / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D061525:Perforator Flap; D012086:Reoperation; D012189:Retrospective Studies; D012535:Scalp; D012878:Skin Neoplasms / Q000601:surgery; D000077195:Squamous Cell Carcinoma of Head and Neck; D013977:Tibia / Q000293:injuries