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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

Thin resurfacing with a superficial inferior epigastric perforator flap. (A) 32-yr-old patient who underwent an amputation of a crushed left hand. (B) After replantation, the hand dorsum required thin resurfacing, and a superficial inferior epigastric perforator flap is harvested. (C) Postoperative 6-month view after resurfacing.
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Figure 6: Thin resurfacing with a superficial inferior epigastric perforator flap. (A) 32-yr-old patient who underwent an amputation of a crushed left hand. (B) After replantation, the hand dorsum required thin resurfacing, and a superficial inferior epigastric perforator flap is harvested. (C) Postoperative 6-month view after resurfacing.

Mentions: The concept of axial flaps developed in the 1970s. A major discovery was the pedicle groin flap described by McGregor and Morgan (2) and McGregor and Jackson (17), based on an incorporated axial blood supply. The importance of the blood supply to the skin flap limited the design of the flap in specific regions of the body to the axial blood supply (2, 5, 18). Subsequently, more detailed knowledge of vascular anatomy allowed better flap selection and refinement (Fig. 5). Owing to the presence of multiple perforators in the inguinal region, flaps became more versatile, and free-style design became possible. Therefore, the term, "groin flap" was not commonly used. Instead, names such as the 'superficial circumflex iliac perforator flap', 'superficial inferior epigastric perforator flap', or 'external pudendal perforator flap' were used (Fig. 6, 7, 8). Before the development of the perforator concept, the method of dissection of an inguinal flap harvest was described in textbooks, and guidelines or landmarks were provided for a safe and successful flap harvest. However, with development of the perforator concept, a greater variety of flap designs became possible and the size and composition of the harvested perforator flaps could be more freely modified. For example, thin perforator flaps from the inguinal region can be used for thin resurfacing of the extremities; a pedicle flap can be used for genital resurfacing; vascularized lymph nodes can be transferred; and bulky flaps for volume replacement can be harvested, such as bulky superficial inferior epigastric perforator flaps for breast reconstruction (8, 19). The more advanced surgical techniques made possible by the perforator concept allowed the conventional donor site to become a "universal donor site", which enabled greater variation in the design, composition, and use of flaps according to the specific needs of the patient. The perforator flap is not a new, difficult flap, but is rather the product of the application of evolving and improved surgical techniques to more common conventional flaps. The inguinal pedicled flap used to be the "flap of choice" for resurfacing of the hand, but now the inguinal area can be source of a wide variety of perforator flaps, depending on what is required.


Perforator Flap versus Conventional Flap.

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

Thin resurfacing with a superficial inferior epigastric perforator flap. (A) 32-yr-old patient who underwent an amputation of a crushed left hand. (B) After replantation, the hand dorsum required thin resurfacing, and a superficial inferior epigastric perforator flap is harvested. (C) Postoperative 6-month view after resurfacing.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Thin resurfacing with a superficial inferior epigastric perforator flap. (A) 32-yr-old patient who underwent an amputation of a crushed left hand. (B) After replantation, the hand dorsum required thin resurfacing, and a superficial inferior epigastric perforator flap is harvested. (C) Postoperative 6-month view after resurfacing.
Mentions: The concept of axial flaps developed in the 1970s. A major discovery was the pedicle groin flap described by McGregor and Morgan (2) and McGregor and Jackson (17), based on an incorporated axial blood supply. The importance of the blood supply to the skin flap limited the design of the flap in specific regions of the body to the axial blood supply (2, 5, 18). Subsequently, more detailed knowledge of vascular anatomy allowed better flap selection and refinement (Fig. 5). Owing to the presence of multiple perforators in the inguinal region, flaps became more versatile, and free-style design became possible. Therefore, the term, "groin flap" was not commonly used. Instead, names such as the 'superficial circumflex iliac perforator flap', 'superficial inferior epigastric perforator flap', or 'external pudendal perforator flap' were used (Fig. 6, 7, 8). Before the development of the perforator concept, the method of dissection of an inguinal flap harvest was described in textbooks, and guidelines or landmarks were provided for a safe and successful flap harvest. However, with development of the perforator concept, a greater variety of flap designs became possible and the size and composition of the harvested perforator flaps could be more freely modified. For example, thin perforator flaps from the inguinal region can be used for thin resurfacing of the extremities; a pedicle flap can be used for genital resurfacing; vascularized lymph nodes can be transferred; and bulky flaps for volume replacement can be harvested, such as bulky superficial inferior epigastric perforator flaps for breast reconstruction (8, 19). The more advanced surgical techniques made possible by the perforator concept allowed the conventional donor site to become a "universal donor site", which enabled greater variation in the design, composition, and use of flaps according to the specific needs of the patient. The perforator flap is not a new, difficult flap, but is rather the product of the application of evolving and improved surgical techniques to more common conventional flaps. The inguinal pedicled flap used to be the "flap of choice" for resurfacing of the hand, but now the inguinal area can be source of a wide variety of perforator flaps, depending on what is required.

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