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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

Tailored reconstruction of the upper lip. (A) A 14-yr-old male presents with a venous malformation on his upper lip and left cheek. (B) The venous malformation is radically resected. (C) A 5×3 cm, thin lateral thoracic perforator flap is designed for upper lip reconstruction. (D) Six months after the surgery, the venous malformation has subsided without recurrence.
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Figure 11: Tailored reconstruction of the upper lip. (A) A 14-yr-old male presents with a venous malformation on his upper lip and left cheek. (B) The venous malformation is radically resected. (C) A 5×3 cm, thin lateral thoracic perforator flap is designed for upper lip reconstruction. (D) Six months after the surgery, the venous malformation has subsided without recurrence.

Mentions: Improved knowledge of the blood supply, together with development of the perforator concept, have increased the variety of soft tissue compositions of flaps available to surgeons (15, 16). Dermoadiposal flaps, adiposal flaps, adipofascial flaps, and myoadipofascial flaps can all be harvested from the same donor sites, allowing for improved tailoring of the flaps and more refinement in their reconstruction (13, 33, 34). For a patient with maxillary cancer, each perforator component of the flap had to be tailored to the size and composition of the defect, which required the reconstruction of the oral lining, nasal lining, and outer resurfacing of the cheek (35). This degree of customized or tailored reconstruction was possible because the perforator flaps can have an appropriate composition that allows them to be inserted into the defect like an assembly of missing blocks. For another patient with a venous malformation of the upper lip, a free flap could be utilized to obliterate the dead space after tumor ablation and to prevent tumor recurrence. After radical resection of the vascular tumor, a perforator flap was tailored to resemble the resected tissue from the tumor (Fig. 11).


Perforator Flap versus Conventional Flap.

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

Tailored reconstruction of the upper lip. (A) A 14-yr-old male presents with a venous malformation on his upper lip and left cheek. (B) The venous malformation is radically resected. (C) A 5×3 cm, thin lateral thoracic perforator flap is designed for upper lip reconstruction. (D) Six months after the surgery, the venous malformation has subsided without recurrence.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 11: Tailored reconstruction of the upper lip. (A) A 14-yr-old male presents with a venous malformation on his upper lip and left cheek. (B) The venous malformation is radically resected. (C) A 5×3 cm, thin lateral thoracic perforator flap is designed for upper lip reconstruction. (D) Six months after the surgery, the venous malformation has subsided without recurrence.
Mentions: Improved knowledge of the blood supply, together with development of the perforator concept, have increased the variety of soft tissue compositions of flaps available to surgeons (15, 16). Dermoadiposal flaps, adiposal flaps, adipofascial flaps, and myoadipofascial flaps can all be harvested from the same donor sites, allowing for improved tailoring of the flaps and more refinement in their reconstruction (13, 33, 34). For a patient with maxillary cancer, each perforator component of the flap had to be tailored to the size and composition of the defect, which required the reconstruction of the oral lining, nasal lining, and outer resurfacing of the cheek (35). This degree of customized or tailored reconstruction was possible because the perforator flaps can have an appropriate composition that allows them to be inserted into the defect like an assembly of missing blocks. For another patient with a venous malformation of the upper lip, a free flap could be utilized to obliterate the dead space after tumor ablation and to prevent tumor recurrence. After radical resection of the vascular tumor, a perforator flap was tailored to resemble the resected tissue from the tumor (Fig. 11).

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