Freestyle Multiperforator Island Flap for Reconstruction of Extensive Thoracoabdominal Defects

Background: Extensive thoracoabdominal defects after oncologic resection pose a major reconstructive challenge, particularly when durable soft-tissue coverage must be achieved over prosthetic chest wall reconstruction. Conventional pedicled flaps and free microvascular options may be constrained by donor-site morbidity, prolonged operative times, or anatomic unsuitability. Methods: We describe the reconstruction of a large thoracoabdominal defect using a Freestyle Multiperforator Island Flap (FMIF) based on deep inferior epigastric artery perforators, after wide excision of recurrent breast carcinoma and partial chest wall resection. The flap was intentionally designed with a reduced pedicular area, enabling direct advancement based on intraoperatively identified perforators to maximize mobility while preserving vascular reliability. Free autologous reconstruction with a deep inferior epigastric artery perforator (DIEP) flap was not feasible due to insufficient abdominal adipose panniculus. Results: The FMIF provided immediate, stable, and well-vascularized coverage of the thoracic defect, including exposed prosthetic mesh and osteosynthesis materials, with complete flap survival and no perioperative complications. At 12-month follow-up, the reconstruction demonstrated durable coverage, satisfactory thoracic contour, and preserved function. Conclusions: A Freestyle Multiperforator Island Flap designed for direct advancement with a reduced pedicular area represents a reliable and efficient reconstructive solution for extensive thoracoabdominal defects, expanding the applicability of perforator-based local flaps and offering a valuable alternative when free-flap reconstruction is not feasible or when operative efficiency and resource optimization are essential.