Freestyle Pedicle Perforator Flaps: Clinical Results and Vascular Anatomy
Bibliographic record
Abstract
BACKGROUND: Perforator flaps have increased in use, with advantages such as sparing of the underlying muscle with resultant decreased donor-site morbidity and the possibility of improving aesthetic outcome. Theoretically, a flap can be based on any perforator, whether free or pedicled, based on the perforasome theory. In this study, the principle of free-style perforator flaps was used to harvest pedicled flaps. METHODS: The authors report the cumulative experience with freestyle perforator flaps of two medical centers (Hôpital Maisonneuve-Rosemont and University of Texas Southwestern Medical Center). Fifty-three pedicled perforator flaps were performed on 49 patients for local reconstruction of a range of defects at various anatomical locations: head and neck (n=3), anterior trunk (n=13), posterior trunk (n=9), perineal/gluteal (n=4), lower limb (n=20), and upper limb (n=4). RESULTS: Complete flap survival was obtained in 48 of 53 flaps. Complications included three cases of partial flap necrosis and two total flap failures, the latter in high-risk patients. Complete primary closure of the donor site was possible in 37 cases, especially in the trunk. Twelve patients had partial primary closure complemented by skin grafting, three cases required complete skin grafting, and one donor site required another local flap for closure. Five clinical examples are given-anterior trunk, posterior trunk, cervical region, lower limb, and upper limb. CONCLUSIONS: This is a large series on clinical applications of the freestyle pedicled perforator flap. Because of its many advantages and its versatility, the authors believe it will find its place as a valued reconstructive option and, when indicated, a simpler alternative to free flaps.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".