A series of eight free flaps were used for extremity reconstruction over the past eighteen months. The series included thoracodorsal artery perforator flaps for exposed joints in the ankle and foot in two children four and nine years of age. Three additional thoracodorsal artery perforator flaps were used for lower extremity open tibial fractures. Two lateral thigh flaps were used for resurfacing of the hand and closure of an open carpal-metacarpal joint. A single Diep flap was used to resurface the knee in a sixteen year old female. A total of four of the eight flaps were used for joint coverage. Three of the four flaps for joint coverage were in the pediatric age group. Successful coverage was achieved in all cases. Two cases of partial flap loss were noted. No cases of complete flap loss were noted in this small series. The two cases of partial flap loss occurred in the cases of the L-Tap flap to the dorsal foot and ankle in the two youngest children. The area of partial necrosis occurred at the distal segment of the flap. The flap loss was along a definite line of demarcatin. The ankle and dorsal foot were well covered and the distal loss in both cases were treated with secondary skin grafting. Secondary thinning of the flaps was accomplished with dissection of the perforator vessels and resection of the fat with the arteriovenous pedicle under direct view. A significant improvment in the expected result with defatting of a flap was obtained with the direct dissection of the pedicle. Secondary defatting of perforator flaps with dissection of the axial vasculature may be accomplished more effectively than the defatting of a random flap which is done with the partial incision and direct fat excision. Joint resurfacing can be accomplished with the use of free perforator flaps with the choice of the donor vessels being selected to minimize the donor deformity. The latissimus thoracodorsal site is concealed beneath the arm. The Diep flap results in the transverse scar of the abdominoplasty and the lateral thigh flap was chosen for the young adult worker involved in manual labor. Muscle sparing in these cases was of benefit to all of the patients. Finally, direct dissection of the arteriovenous pedicle and defatting, results in a contour refinement equal to the perforator flaps defatted at the time of the original flap elevation.