title: Free-Flap Reconstruction: What Do Microsurgeons Prefer for Themselves?
abstract: Background The recent development of perforator flaps has changed the reconstructive strategy for common integumental defects and has refocused the attention of microsurgeons to donor site morbidity. We asked a representative panel of microsurgeons about the free flap they would use to cover a common integumental defect on their own body to investigate the best free-flap donor sites. Methods In total, 100 practitioners participated in the "FreeFlap4U" study, representing 77.3% of the French national plastic surgery teams practicing microsurgery. To assess changing attitudes, we also compared microsurgeons below 40 years of age (called junior microsurgeons, JMs) with those above 40 years of age (called senior microsurgeons, SMs). Results Perforator flaps were preferred for the first line (JMs) and second line (JMs and SMs) of treatment compared with other flaps. JMs emphasized lower donor site morbidity, whereas SMs favored reliability (p = 0.013) and considered perforator flaps as a second-line treatment. Radial forearm and transverse rectus abdominis flaps were largely dismissed due to high morbidity. Some microsurgeons were influenced by the potential secondary benefit of the integument sample at the donor site. Conclusions Microsurgeons interviewed clearly moved toward perforator flaps, such as the anterolateral thigh, thoracodorsal artery perforator, and superficial circumflex iliac artery types, to cover common integumental defects. In the coming years, we believe that this choice, emitted by the microsurgeons for themselves, will be applied extensively by these surgeons for their patients.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Chaput
authors.affiliation: Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital, Lyon, France.
authors.forename: Ali
authors.initials: A
authors.lastname: Mojallal
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bertheuil
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, Rennes, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Carloni
authors.affiliation: Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Grolleau
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nord University Hospital, Amiens, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Sinna
authors.affiliation: Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Bekara
authors.affiliation: Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Herlin
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D058752:Free Tissue Flaps; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D057240:Patient Preference; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D066231:Surgeons / Q000706:statistics & numerical data