الفهرس 
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Abstract
Perforator flap has widened the array of options for reconstructive surgeons. Because of its relatively recent introduction, doubts regarding its reliability have overshadowed its safety in clinical practice.
We found perforator flaps to be a reliable tool for upper extremity coverage, with a low rate of failure and secondary surgery. These flaps are particularly useful for covering small- and medium-sized defects in the distal one third of the forearm, wrist, and hand; and they represent a reliable and effective alternative to free flaps.
The main advantage of a perforator flap is that it does not require division of the underlying main vessel. Although dissection of a perforator can be difficult especially if the course is intramuscular, a perforator-based propeller flap for the upper limb has a good tissue match, 180° arc of rotation and reliability.
Although we did not compare the outcomes of propeller and free flaps, propeller flaps seem to have an incidence of total flap necrosis similar to that of free flaps. However, even if minor problems occurred more frequently with propeller flaps, in all patients revision surgery was not needed.
Perforator flaps provide a like with like reconstruction, with minimal morbidity at the donor site and no need for microvascular anastomosis. They can be done under regional anesthesia, and they are relatively quick to harvest. Nevertheless, we caution surgeons using these flaps to pay particular attention to adequate dissection of the pedicle and to avoid compression from edema or other extrinsic causes, which may reduce the drainage of the venae comitantes and may lead to complications.
Perforator flaps are a valid reconstructive option for difficult wounds and can be raised from any part of the body. Their harvesting is easy and fast, provided that an accurate dissection technique is applied, and allows for great freedom in design and choice of the donor site.
Perforator flaps represent an alternative to free flaps when traditional flaps are not an option, allow to reconstruct even complex wounds with local tissues and a low donor-site morbidity, and present several advantages over traditional pedicled flaps: their freedom in design allows to reconstruct complex defects usually requiring multiple procedures in a single stage, accelerating recovery, minimizing morbidity and discomfort for the patient, and allowing a better aesthetic result and concealing of scars.