Conventional Liposuction-Assisted Debulking of Muscle Perforator Flaps

In Brief Late recontouring of the usual bulky cutaneous flap via conventional liposuction is an accepted practice and usually without fear of tissue necrosis. Muscle perforator flaps, on the other hand, initially depend only on often fragile, minuscule vessels that could readily be traumatized by any form of suction-assisted lipectomy. Single-staged muscle perforator flap debulking was thus performed with some trepidation for 8 flaps in 7 patients. All flaps ultimately remained successful, but in 2 cases obvious tissue ischemia delayed healing. It can only then be assumed that this adjunctive technique places all perforators at jeopardy for injury. Survival of the given flap may then depend solely on neovascularization from the recipient site, and that must be protected to retain pedicle independence, or otherwise flap necrosis would ensue. Thus, the timing of muscle perforator flap debulking could then be critical. Although that averaged 9.1 months (range, 3–15 months) after flap transfer in this series, the observed ischemia occurred at both ends of this spectrum. Eight muscle perforator flaps were debulked in a single stage with liposuction. Two flaps demonstrated tissue ischemia with delayed healing following the procedure, presumably from mild injury to the perforators.