This is a large series on clinical applications of the freestyle pedicled perforator flap. Because of its many advantages and its versatility, the authors believe it will find its place as a valued reconstructive option and, when indicated, a simpler alternative to free flaps.

The anatomy of the lateral forearm flap has been studied in 12 fresh cadaver arms with methylene blue and latex injections and arteriography. The posterior radial collateral artery was found to divide constantly into two terminal branches, an anterior and a posterior division. The anterior division is the nutrient vessel of the flap. This artery extends significantly beyond the lateral epicondyle of the elbow into the lateral aspect of the forearm (range 13 to 18 cm, average 15 cm). This allows raising a fasciocutaneous flap in the proximal forearm with a much longer vascular pedicle than the classic lateral arm flap. Other advantages include very thin skin and subcutaneous tissue and less sensory deficit at the donor site. Based on these results, this newly designed lateral forearm flap has been used in 13 clinical cases. Its main indications are whenever soft, thin, pliable skin is needed for small to moderate-sized defects.