Perforator flaps: the next step in the reconstructive ladder?

Perforator flaps are claimed to be a sign of major progress in head and neck reconstruction, but are they a further step up the reconstructive ladder? In this paper I provide a short summary of the development and current clinical use of perforator flaps in the head and neck, which is based on a presentation to the annual meeting of the British Association of Oral and Maxillofacial Surgeons in 2014. I will describe 4 flaps from the lower leg, which are useful specifically for covering intraoral defects, as examples. When we consider the spectrum of new donor sites, and the precision of flap design that is offered by perforator flaps, it becomes evident that the potential of this new technique has not yet been reached.