LAUSR

INTRODUCTION The traditional design for truncal perforator flaps are ipsilateral without midline decussation. The presumed rational is to minimize the risk of distal flap necrosis. In this paper we present our experience and results contralateral truncal perforator flaps designed and raised crossing the midline. METHODS This retrospective analysis included 43 patients (25 men and 18 women) who underwent reconstructive surgery from 1984 to 2021 using a contralateral flap design crossing the midline in the anterior trunk and upper back. Considerations included: pathology, location, as well as the dimensions of the defect and flap. An arithmetic and weighted mean with their 95% CI was estimated to compare ipsilateral and contralateral techniques. RESULTS Contralateral flaps utilized included the internal mammary perforator flap (n=28) superficial superior epigastric artery (n=8), superior epigastric perforator (n=2), and the 2 nd or 9 th dorsal intercostal artery perforator flaps (n=5). All of these flaps excluding the superficial superior epigastric artery demonstrated length and coverage surface averages that were significantly greater than those traditional ipsilateral flaps. However, with the contralateral superficial superior epigastric artery, both measures were statistically similar to those traditional ipsilateral flaps. CONCLUSIONS The anatomic variation design suggests that trunk midline is not a barrier and that perforator flaps in these two regions may be raised on different longitudinal axes without compromising vitality.