Free-Style Perforator Flaps for Acute Reconstruction of Large Soft-Tissue Defects in Patients Presenting to the Emergency Department

Aim: This study aimed to systematically evaluate the efficacy and safety of freestyle perforator flaps in the acute setting and to analyze predictors of postoperative complications.Methods: This retrospective study included patients aged 18 years and older who presented to the emergency department of a university hospital between February 1, 2023, and November 30, 2023, with acute traumatic injuries or non-healing wounds. Patients who were identified during initial emergency department evaluation and management as having extensive soft tissue defects and subsequently underwent reconstruction using a freestyle perforator flap were included in the analysis.Results: The study included 20 patients who underwent reconstruction with freestyle perforator flaps. No statistically significant associations were found between age, sex, etiology, or flap size and complication occurrence. There was no significant difference in complication rates between single-perforator and double-perforator flaps. Complications were most common after nasal reconstruction. All cases requiring secondary skin grafting for donor-site closure occurred in patients who underwent lower extremity reconstruction.Conclusion: Freestyle perforator flaps may be considered a fast, versatile, and reliable option for the acute management of large soft-tissue defects requiring emergency reconstruction across different anatomical regions.