ArticlePlastic and reconstructive surgery. Global open2025
The Freestyle Multiperforator Island Flap: Beyond the Keystone Flap.
Article in Plastic and reconstructive surgery. Global open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Keystone Flap, a Versatile Option for Salvaging Infected Spinal Instrumentation Associated to Soft-tissue Defects: A Novel Option.Plastic and reconstructive surgery. Global open · 2026Article
- Evolution of cervicofacial flaps: From classical reconstruction to Freestyle Multiperforator Island Flap.JPRAS open · 2026Article
- Uneasy (Intractable) Head and Neck Defect Coverage With Easy and Reliable Local Flap Techniques: A Retrospective Case-Based Study of Perforator-Plus Peninsular Flap and Modified Keystone Flap.Laryngoscope investigative otolaryngology · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: This study aimed to introduce freestyle multiperforator island flaps as a technical advancement beyond keystone perforator flaps. These flaps represent a fully free-design approach, supplied by multiperforators in small subcutaneous pedicles randomly located, allowing for customized designs tailored to anatomical regions of diverse complexity. Methods: We present a retrospective cohort study of 150 patients with coverage defects, without distinction of anatomical location or age, treated between 2012 and 2021. The study assessed the clinical presentation, flap characteristics, additional procedures, and postoperative outcomes. We used the chi-square test to assess the relationship between pedicle area size and the incidence of partial or complete necrosis. Results: We performed 211 flaps on 184 defects, with a mean follow-up of 8.7 months. Tumors (30.4%) and trauma (23.3%) were the most common etiologies. Most flaps were performed on the head and neck (31%) and lower limbs (30.4%). The mean pedicle area was 33%, and the flap-to-defect size ratio was between 1:1 and 3:1 in 82% of cases. Complications occurred in 29.8% of the flaps, with only 8.1% needing surgical reintervention. The most common occurrences were dehiscence (18.5%), partial necrosis (9%), and total necrosis (1.9%). The pedicle area of the flap did not demonstrate a statistically significant relationship with the necrosis outcome ( Conclusions: Freestyle multiperforator island flaps are a safe and versatile tool with low necrosis rates, excellent aesthetic results, and unmatched cost-effectiveness.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.