Product Description

This course examines four alternate soft-tissue free flaps—the ulnar artery perforator, lateral arm perforator, medial sural artery perforator, and profunda artery perforator flaps—for complex head and neck reconstruction when conventional workhorse donor sites are unavailable or unsuitable. Drawing on a 10-year single-surgeon experience with 156 flaps, the paper compares flap characteristics, common indications, pedicle anatomy, sensory and chimeric options, donor-site morbidity, and technical considerations that influence flap selection. The findings demonstrate a low overall flap-loss rate and support incorporating these donor sites into the reconstructive microsurgeon’s armamentarium while emphasizing careful patient selection, knowledge of anatomic variation, and strategies to minimize complications. 

Intended Audience

This educational activity is intended for all CME-related persons including plastic surgery practitioners, residents, and other healthcare professionals.

Learning Objectives

After viewing this course, the participant should be able to:

1. Describe the indications and reconstructive roles of the ulnar artery perforator, lateral arm perforator, medial sural artery perforator, and profunda artery perforator flaps.
2. Compare alternate soft-tissue free flaps based on tissue thickness, pliability, pedicle length, vessel caliber, sensory potential, and chimeric design.
3. Select an appropriate alternate donor site according to defect characteristics, patient body habitus, recipient-vessel availability, and functional goals.
4. Identify flap-specific technical considerations and donor-site risks, including nerve injury, wound dehiscence, compartment syndrome, and anatomic variation.
5. Evaluate the reported reliability, complications, and limitations of alternate free flaps used for complex head and neck reconstruction.

Faculty:

Edward I. Chang, MD, FACS

Plastic and Reconstructive Surgery Editors

Editor-in-Chief: Kevin C. Chung, MD

Co-editor: Amy S. Colwell, MD

CME Faculty:

Margaret Roubaud, MD

Joshua Vorstenbosch, MD

Accreditation

The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation

The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 CreditTM: 1.0

Media: Journal Article

Release Date: 8/4/2026

Expiration Date: 8/4/2029*

Estimated time to complete this course: 1 hour

*Course access ends on course expiration date

Disclosure Policy

The American Society of Plastic Surgeons (ASPS) requires all instructors, planners, reviewers, managers and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. ASPS also requires faculty/authors to disclose when off-label/unapproved uses of product are discussed in a CME activity or included in related materials.

Disclaimer: All relevant financial relationships for planners, faculty and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable.

The following planners and faculty members have no relevant financial relationships or affiliations to disclose:

Edward I. Chang, MD, FACS

Margaret Roubaud MD

Joshua Vorstenbosch MD

Recognition Statement

The Continuing Medical Education (CME) credits offered by this activity are enhanced by ASPS Learner Credit Reporting for learners who have opted into this reporting. Successful completion of this CME activity enables active American Board of Surgery (ABS) members the opportunity to earn credit toward the CME requirement of the ABS's Continuous Certification program when claimed within 30 days of completion of the activity.

Directly provided by the American Society of Plastic Surgeons® (ASPS®)

Participants in ASPS-accredited education who want their CME credits reported to certifying and state licensing boards must opt-in to reporting and add their NPI as well as state license ID and/or collaborating board ID(s) before claiming credit.

Product Code: