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Perforator Flap versus Conventional Flap.

Kim JT, Kim SW - J. Korean Med. Sci. (2015)

Bottom Line: Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved.The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery.No doubt the technique will continue to evolve.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.

ABSTRACT
The introduction of perforator flaps represented a significant advance in microsurgical reconstruction. However, confusion has developed due to the erroneous belief that perforator flaps are different from conventional flaps. The concept of the perforator is not new, but is an idea that evolved from the conventional flap. In fact, some of the flaps used by microsurgeons were perforator flaps. The only difference is the anatomical level of the blood vessels involved; the perforator concept is focused on the distal circulation, so-called 'perforator'. Therefore, thinner sections of tissue can be taken from the conventional donor sites of myocutaneous flaps. With the use of perforators, there are no longer "flap of choice" for specific reconstructions, because conventional donor sites have become universal donor sites, enabling the harvesting of a variety of flaps. Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved. Therefore, tissues can be efficiently customized and tailored into any configuration required for reconstruction. The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery. No doubt the technique will continue to evolve.

No MeSH data available.


Related in: MedlinePlus

Vastus lateralis perforator flap. (A) A 57-yr-old male patient has cellulitis after a crush injury to the right foot that required amputation. (B, C) A 12×15 cm Vastus lateralis perforator flap is elevated based on musculocutaneous perforators. (D) Postoperative view at 12-month follow-up.
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Figure 2: Vastus lateralis perforator flap. (A) A 57-yr-old male patient has cellulitis after a crush injury to the right foot that required amputation. (B, C) A 12×15 cm Vastus lateralis perforator flap is elevated based on musculocutaneous perforators. (D) Postoperative view at 12-month follow-up.

Mentions: Most skin flaps are now elevated based on their perforator instead of on their source vessel or branch, and direct cutaneous perforators (DCp) should also be included in the perforator group (3, 10, 15). However, in terms of the level of surgical dissection required septocutaneous perforators and DCps, which are not very different from each other, should be differentiated from musculocutaneous perforators, which require transmuscular dissection during elevation (14). Therefore, perforator flaps based on musculocutaneous perforators are named after the muscle involved. On the other hand, flaps based on a septocutaneous perforator or direct cutaneous perforator are named after their source vessel (Fig. 2, 3) (10). A flap based on a perforator itself, without further proximal dissection, is referred to as a perforator-"based" flap and is named after the associated muscle (MCp) or vessel (SCp) (Fig. 4) (10, 16).


Perforator Flap versus Conventional Flap.

Kim JT, Kim SW - J. Korean Med. Sci. (2015)

Vastus lateralis perforator flap. (A) A 57-yr-old male patient has cellulitis after a crush injury to the right foot that required amputation. (B, C) A 12×15 cm Vastus lateralis perforator flap is elevated based on musculocutaneous perforators. (D) Postoperative view at 12-month follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414633&req=5

Figure 2: Vastus lateralis perforator flap. (A) A 57-yr-old male patient has cellulitis after a crush injury to the right foot that required amputation. (B, C) A 12×15 cm Vastus lateralis perforator flap is elevated based on musculocutaneous perforators. (D) Postoperative view at 12-month follow-up.
Mentions: Most skin flaps are now elevated based on their perforator instead of on their source vessel or branch, and direct cutaneous perforators (DCp) should also be included in the perforator group (3, 10, 15). However, in terms of the level of surgical dissection required septocutaneous perforators and DCps, which are not very different from each other, should be differentiated from musculocutaneous perforators, which require transmuscular dissection during elevation (14). Therefore, perforator flaps based on musculocutaneous perforators are named after the muscle involved. On the other hand, flaps based on a septocutaneous perforator or direct cutaneous perforator are named after their source vessel (Fig. 2, 3) (10). A flap based on a perforator itself, without further proximal dissection, is referred to as a perforator-"based" flap and is named after the associated muscle (MCp) or vessel (SCp) (Fig. 4) (10, 16).

Bottom Line: Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved.The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery.No doubt the technique will continue to evolve.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.

ABSTRACT
The introduction of perforator flaps represented a significant advance in microsurgical reconstruction. However, confusion has developed due to the erroneous belief that perforator flaps are different from conventional flaps. The concept of the perforator is not new, but is an idea that evolved from the conventional flap. In fact, some of the flaps used by microsurgeons were perforator flaps. The only difference is the anatomical level of the blood vessels involved; the perforator concept is focused on the distal circulation, so-called 'perforator'. Therefore, thinner sections of tissue can be taken from the conventional donor sites of myocutaneous flaps. With the use of perforators, there are no longer "flap of choice" for specific reconstructions, because conventional donor sites have become universal donor sites, enabling the harvesting of a variety of flaps. Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved. Therefore, tissues can be efficiently customized and tailored into any configuration required for reconstruction. The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery. No doubt the technique will continue to evolve.

No MeSH data available.


Related in: MedlinePlus