Evolution of cervicofacial flaps: From classical reconstruction to Freestyle Multiperforator Island Flap.

Background: This study presents a cost-effective and safe alternative for facial reconstruction, introducing the concept of the Freestyle Multiperforator Island Flap (FMIF) a subcutaneously based flap that can be customized in both location and size. Its versatility stems from the extensive vascular cutaneous territories supplied by the dermal and facial plexuses, which branch in an arborescent pattern to ensure reliable perfusion across multiple facial regions. Methods: A retrospective case series of 34 patients (37 flaps) with cheek defects treated between 2012 and 2022 is presented. Demographic profiles, defect etiology, flap characteristics, and postoperative outcomes were analyzed. Results: A total of 37 flaps were performed in 34 patients. The most common etiology was malignant tumors (83.7 %), squamous cell carcinoma (43.2 %), basal cell carcinoma (29.7 %), and melanoma (10.8 %), followed by benign tumors (10.8 %) and others (5.4 %).Twenty-five flaps were used for the reconstruction of the parotid-masseteric subunit, with 54 % designed at a flap-to-defect ratio ranging from 5:1 to 10:1.In 29 flaps (78.37 %), the average pedicle area was 16.2 % (range: 10 %-20 %).Regarding outcomes, major complications occurred in five flaps, with partial necrosis and dehiscence being the most frequent (5.4 % each). No total flap loss was reported. Conclusions: The FMIF offers a safe, versatile, and cost-conscious option for facial reconstruction, providing reliable perfusion and minimal donor-site morbidity through its adaptable pedicle design. Although early outcomes are favorable, the absence of a control group limits definitive conclusions. Future comparative and anatomical studies are required to validate its vascular basis, safety, and role alongside established reconstructive techniques.