{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T22:09:57Z","timestamp":1783634997977,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T00:00:00Z","timestamp":1726012800000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The use of free\u2010style and propeller perforator\u2010based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator\u2010based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from <jats:italic>angiosomal<\/jats:italic> to <jats:italic>bi\u2010angiosomal<\/jats:italic> and <jats:italic>extra\u2010angiosomal<\/jats:italic> perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>A total of 15 patients underwent abdominal wall reconstruction with <jats:italic>angiosomal<\/jats:italic>, <jats:italic>bi\u2010angiosomal<\/jats:italic>, and <jats:italic>extra\u2010angiosomal<\/jats:italic> pedicled perforator\u2010based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft\u2010tissue sarcomas (STS) and non\u2010melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post\u2010operative course, and complications were recorded. Moreover, at 12\u2009months follow\u2010up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5\u2010point Likert scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten <jats:italic>angiosomal<\/jats:italic> perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 <jats:italic>bi\u2010angiosomal<\/jats:italic> and <jats:italic>extra\u2010angiosomal<\/jats:italic> conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP\u2010SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3\u2009years. Defect sizes ranged from 98 to 408\u2009cm<jats:sup>2<\/jats:sup> (mean size was 194.7\u2009cm<jats:sup>2<\/jats:sup>). Mean operative time was 280\u2009min. Flap surface ranged from 108 to 336\u2009cm<jats:sup>2<\/jats:sup> (mean surface was 209.3\u2009cm<jats:sup>2<\/jats:sup>). No major complications were registered. One <jats:italic>bi\u2010angiosomal<\/jats:italic> bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12\u2010month follow\u2010up except one, who did not show for clinical follow\u2010up but responded at the Likert scale at clinical follow\u2010up at 9\u2009months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The use of local tissues is an under\u2010utilized solution in the field of abdominal wall reconstruction. <jats:italic>Angiosomal<\/jats:italic>, <jats:italic>bi\u2010angiosomal<\/jats:italic>, and <jats:italic>extra\u2010angiosomal<\/jats:italic> perforator flaps proved to be a reliable option to provide the transfer of a significant amount of tissue and offer like with like reconstruction while maximizing flap survival.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31229","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T09:13:24Z","timestamp":1726046004000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["From Angiosomal to Bi\u2010Angiosomal and Extra\u2010Angiosomal Pedicled Perforator Flaps: Optimizing the Use of Local Tissues in Abdominal Wall Reconstruction"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4863-3926","authenticated-orcid":false,"given":"Beniamino","family":"Brunetti","sequence":"first","affiliation":[{"name":"Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery Fondazione Policlinico Universitario Campus bio\u2010Medico  Roma Italy"},{"name":"Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery Universit\u00e0 Campus bio\u2010Medico di Roma  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8910-6586","authenticated-orcid":false,"given":"Marco","family":"Morelli\u00a0Coppola","sequence":"additional","affiliation":[{"name":"Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery Fondazione Policlinico Universitario Campus bio\u2010Medico  Roma Italy"},{"name":"Research Unit of Plastic, 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