Free-style local perforator flaps: concept and classification system.

BACKGROUND: Defect reconstruction according to the free-style concept applied to perforator flaps allows flap harvesting in any anatomical region where an audible Doppler signal of a perforator is detected. We report the results of a study in which local perforator flaps were selected for reconstruction in different anatomical areas and were harvested using the free-style concept. METHODS: During a 2-year period, defect coverage was carried out in 21 patients (n=21) in the following anatomical areas: cervical (n=3), sternal/parasternal (n=4), axillary (n=2), tibial (n=5), trochanteric (n=2) and sacral/gluteal (n=5). The mean age of patients (15 male and six female) was 57.8 years. Flap selection was based solely on preoperative Doppler mapping in areas adjacent to soft-tissue defects. The mean follow-up period was 1 year. RESULTS: All flaps survived, demonstrating postoperatively acceptable aesthetic results with good patient satisfaction. The donor sites were closed primarily in 17 patients; four patients required skin grafting. Two patients required surgical revision due to flap-margin dehiscence. There was no loss of function at donor sites. Increased flap mobility could be achieved through extended perforator dissection. One perforator-based flaps offered the widest arc of rotation serving as propeller flaps. If more than one perforator vessel was preserved, flap mobility was limited, but still allowed sufficient flap movement either as a rotation or advancement flap or as a combination of both. A classification is proposed according to the number of perforator vessels preserved and to the type of flap movement. CONCLUSIONS: The concept of free-style local perforator flaps represents a safe, versatile and reliable surgical procedure. It not only offers a greater freedom in flap selection but also provides good aesthetic results. The classification proposed might aid in the decision-making process involved in order to achieve adequate results with this procedure.

Closed-open rhinoplasty with extended lip dissection: a new concept and classification of rhinoplasty.

BACKGROUND: Open rhinoplasty represents a surgical technique that has increased in popularity during the past several decades. However, to achieve full access to the entire nasal framework, a transcolumellar incision is required. In this study, the authors present the results of a rhinoplasty technique avoiding the transcolumellar incision while offering full access to the entire osteocartilaginous framework. METHODS: Twenty-four patients (17 women and seven men) with a mean age of 28.7 years (range, 21 to 49 years) were the subjects of this study. Four patients underwent secondary rhinoplasty and 20 patients underwent primary rhinoplasty. The surgical procedure comprises an alar base resection incision with thorough undermining of the anatomical area between the nasal base and the upper lip, allowing nondistorted access to the entire osteocartilaginous framework and performance of all standard rhinoplasty techniques. A transcolumellar incision is not performed. The minimum follow-up period was 12 months. RESULTS: All 24 patients expressed a high degree of satisfaction with the surgical result achieved. Postoperative swelling and initial lip dysesthesia resolved in all cases within the first 6 weeks without any morphologic or functional sequelae. Considering different rhinoplasty approaches, a classification of the existing surgical procedures is proposed. CONCLUSIONS: The authors believe the rhinoplasty technique presented in this article is a combination of closed and open approaches. It offers excellent access to the entire osteocartilaginous framework, while preserving the columella. The proposed rhinoplasty classification may simplify and aid the surgeon in deciding among the different rhinoplasty techniques.