Abstract
The free arterialized venous flap is thin, pliable, and easy to elevate and causes minimal donor site morbidity. In addition, it is easy to perform vascular anastomosis using this flap because of the large caliber of its vessels. However, the size of such flaps seems to be limited, and congestion and partial necrosis are common due to the flap's non-physiological circulation. When elevating a venous flap, some perforators can be detected under a microscope. Sometimes, sizable perforators that are well matched with the recipient arteries are encountered, and it is possible to convert the venous flap into a perforator flap in such cases. If a flap does not contain a sizable perforator or the vascular anastomosis of the perforators to the recipient arteries is unsuccessful, the grafting of the venous flap can be performed in the usual manner. Microsurgeons who are familiar with venous flaps can safely adapt the supermicrosurgery techniques they employ in this manner. Preoperative screening using color Doppler Ultrasonography is very useful for aiding the efficient identification of sizable perforators that are suitable for anastomoses and tracing them to their deep main trunks. Free-style free perforator flaps can be designed and harvested from the standard venous flap harvesting sites.
