Aim of study: The aim of this prospective clinical study was developing a free fat flap with minimal or without donor site morbidity and without aesthetic limitation or even with aesthetic improvement.

Background: Some facial reconstructive surgeries require fat restoration in a bigger amount than it might be possible to achieve with free autologous fat grafting and lipofilling. It would be desirable to harvest a free fat flap without skin excision and if we have localized excessive fat tissue even with an aesthetic improvement.

Method: We dissected 5 anterior abdominal walls of anatomic cadavers, to search and analyze possible perforator vessels and fat flaps useful for microsurgery.

On 20 patients we performed an abdominoplasty. We localized the perforator vessels of the deep inferior epigastric artery (DIEA) and measured the intercellular oxygen saturation and temperature.

Results: In one patient with an unilateral hemifacial cleft who desired the restoring of the buccal fat on that hollow cheeked side, we developed a fat tissue flap.

Conclusion: The perforator vessels (DIEP) of the deep inferior epigastric artery (DIEA) around the umbilicus were localized and chosen to be the best in consideration of the vessel caliber and the donor side morbidity. The flap can also be harvested in a standard abdominoplastic procedure with achievable aesthetic improvement. It is possible to develop a poor DIEP fat flap without skin excision and minimal donor side effects for facial reconstructive purposes.

Conflict of interest: None declared.