Freestyle facial perforator flaps—a safe reconstructive option
for moderate-sized facial defects
Gudjon Leifur Gunnarsson
Ian Thomas Jackson
Jorn Bo Thomsen
Received: 10 December 2013 /Accepted: 5 February 2014 /Published online: 5 March 2014
Springer-Verlag Berlin Heidelberg 2014
Background Perforators are a constant anatomical finding in
the facial area and any known flap can in theory be based on
the first perforator located at the flap rotation axis.
Methods A case series of single stage reconstruction of mod-
erate sized facial defects using 21 perforator based local flaps
in 19 patients from 2008–2013.
Results A sufficient perforator was located in every case and
the flap rotated along its axis (76 %) or advanced (24 %).
Reconstruction was successfully achieved with a high self
reported patient satisfaction. Two minor complications oc-
curred early on in the series and corrective procedures were
performed in four patients.
Conclusions The random facial perforator flap seems to be a
good and reliable option for the reconstruction of facial sub-
units, especially the periorbital, nasal and periocular area with
a minimal morbidity and a pleasing result in a one stage
Level of Evidence: Level IV, therapeutic study
Keywords Local flaps
Local flaps, when present, are considered the best reconstruc-
tive option for moderate-sized defects in the face . The axial
pattern nasolabial and forehead flaps are work horse flaps for
coverage of the nasal and perinasal areas due to their rich
vascularity, consistent and reliable anatomy enabling a long
and flexible flap on a narrow pedicle [2, 3]. The limitations of
local flaps are most often due to their limited range of motion
and bulkiness at the pedicle site, necessitating a delay and a
secondary procedure. The importance of a successful recon-
struction of the facial features is apparent due to its exposure,
and a simple single-stage method is therefore preferable if
available. The purpose of this paper is to share our experience
using the workhorse local flaps designed as freestyle
perforator-based flaps for the reconstruction of moderate-
sized facial skin defects.
Material and methods
Facial tumor removal was performed in 19 patients at
Telemark Hospital, Norway, and at Odense University
Hospital/Lillebaelt Hospital, Denmark, from 2008 to 2013.
The patients, nine women and eight men, ranging from 38 to
86 years (median age, 71 years) were treated for basal cell
carcinoma (BCC) (n=14), squamous cell carcinoma (SCC)
(n=1), morbus Bowen (n=1), lentigo maligna (n=1), actinic
keratosis (n=1), and malignant melanoma (n=1); see Table 1.
Sixteen of the flaps were rotated as propeller flaps, 76 %, and
five were advanced in a V-Y fascion 24 %. A suitable perfo-
rator was identified at the predicted location in every case. The
most frequent flap location was nasolabial (NL) in 11 cases,
followed by four jowl and NL/jowl, three supratrochlear, one
cheek and NL, one zygomatic and one orbicularis oculi
musculocutanous flap a modified Trepier; (see Table 1).
G. L. Gunnarsson (*)
Department of Plastic Surgery, Telemark Hospital, Skien, Norway
I. T. Jackson
Ian Jackson Craniofacial & Cleft Palate Clinic, Beaumont Children’s
Hospital, Royal Oak, MI, USA
J. B. Thomsen
Department of Plastic Surgery, Odense University Hospital,
Eur J Plast Surg (2014) 37:315–318