Recycled free septocutaneous perforator flap.

In planning the sequential transfer of free flaps with an adequate time interval, the transferred prior flap can be considered a potential donor site when it becomes partially dispensable as a result of redundancy. Increased control of the range of flap thickness is one of the advantages of a perforator flap. Therefore, a transferred perforator flap with a redundancy in thickness could be reelevated later as a thin perforator flap that leaves significant subcutaneous tissue intact. We present an unusual case in which a prior free perforator flap was reelevated as a thin flap and transferred as a free flap to another location. Two years after the first transfer, the medial thigh septocutaneous perforator-based flap in the calf region was elevated again, with only the inclusion of a thin subcutaneous layer based on the same perforator pedicle, and was moved as a free flap to the anterior tibial region. The use of a prior perforator flap as a donor site for a later flap can avoid the additional sacrifice of a new donor site. The recycling of redundant perforator flaps to yield another flap through tangential splitting is another advantage of perforator flaps.