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Objective: To investigate the effectiveness of free-style perforator flap in repairing the soft tissue defect of knee., Methods: Between December 2011 and October 2017, 13 patients with the soft tissue defects of knees were repaired with the free-style perforator flaps. There were 9 males and 4 females, with an average age of 40 years (range, 14-65 years). The injuries were caused by traffic accident in 7 cases, crushing in 4 cases, and falling from height in 2 cases. The soft tissue defects in 9 cases formed after 2 weeks-2 months (mean, 1 month) of lower extremity fractures fixation. The other 4 cases were urgently admitted to the hospital after injury, and the time from injury to admission was 0.5-18.0 hours (mean, 8 hours). The size of soft tissue defect ranged from 3 cm×2 cm to 12 cm×8 cm after debridement. Nine propeller flaps, 6 rotating flaps, and 2 V-Y advanced flaps were used; and 9 cases were repaired by single flap and 4 cases were repaired by combined flaps. The size of flap ranged from 7.5 cm×2.5 cm to 20.0 cm×6.0 cm. The donor sites were sutured directly., Results: The flaps survived smoothly and incisions healed by first intention in 12 cases. The congestion occurred in 1 case, which obtained delayed healing after symptomatic treatment. All incisions at donor sites healed by first intention. All patients were followed up 3-24 months with an average of 6 months. The shape and motions of knee were satisfactory., Conclusion: The free-style perforator flap can maximize the utilization of the donor area around the knee wound, with reliable blood supply, small trauma, and easy operation. It is an ideal flap for the soft tissue defect of knee.

Background: The single-stage reconstruction of large facial defects remains a conundrum due to the balance between function and aesthetics after skin cancer radical resection., Objective: The goal of this study was to explore a novel surgical procedure for large facial defects that not only resurfaces the large defect in single stage but also improves aesthetic outcomes for both defects and donor sites., Methods: The reconstructions were performed using local flaps in the form of a "jigsaw puzzle" flap based on a freestyle perforator and facial aesthetic unit. This procedure starts with a Doppler signal of the perforator and proceeds sequentially in conjunction with adjacent flaps, similar to fitting puzzle pieces, to create a new, large, jigsaw puzzle-like flap that complies with the concept of a facial aesthetic unit. All defects achieved tensionless primary closure with suturing in a concealed area., Results: Procedures were performed for 40 patients; the average size of the defects was 37 cm (range, 6-51 cm). The patients were followed up for a range of 6 months to 2 years, and reconstruction without flap loss was 100% successful., Conclusion: Via a jigsaw puzzle flap based on a freestyle perforator and an aesthetic unit, we can take advantage of a greater freedom of flap selection and have a more versatile aesthetic design. The jigsaw puzzle flap concept represents a safe and favorable approach to the reconstruction of large facial defects.

Objective: To investigate the clinical application of the modified keystone perforator island flap for reconstruction of skin defects at head and face., Methods: From January 2013 to September 2014,13 cases with skin defects at head and face were repaired by modified keystone perforator island flap. The skin defects ranged from 0.8 cm× 1.0 cm to 20.0 cm × 10.0 cm. And the flap size ranged from 1.5 cm × 1.0 cm to 22.0 cm × 12.0 cm. The flap was designed along the edge of the defect, the vascular supply was supported by muscular perforators. In order to relieve suture tension and have a good cosmetic effect, auxiliary incisions should be as less as possible. Flap should be designed to hide parts of facial incision or surgical margins within the natural borders of each facial unit, or along the direction of striae. Incision within the hairline should be taken to minimize damage to the hair follicles. The direction of hair growth shouldn't be changed after the flap transfer., Results: All cases had 1-12 months' follow-up period.12 flaps survived completely, with one partial flap necrosis. The flaps had good appearance with high aesthetic satisfactory., Conclusions: The modified keystone perforator island flap produces excellent aesthetic results. It can be a very useful flap for the individual reconstruction of skin defects at head and face.