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Perforator flaps in lower extremity reconstruction
I Koshima1, Y Nanba, T Tsutsui
1Department of Plastic and Reconstructive Surgery, Okayama University Medical School, Okayama, Japan. plakoshi@cc.okayama-u.ac.jp
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|December 20, 2002
Summary
Perforator flaps, defined by their unique vascular supply, offer advantages over traditional fasciocutaneous flaps. These flaps provide minimal donor-site morbidity and reliable skin territory for reconstruction.
Area of Science:
- Plastic Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- The concept of perforator flaps was introduced in 1985, challenging the prevailing understanding of fasciocutaneous flap vascularization.
- Perforator flaps are skin flaps nourished by perforating vessels, distinct from the fascial plexus theory.
- Classification of perforator pedicles includes septocutaneous, muscular, periosteal, and intertendinous types.
Observation:
- The perforator flap concept was proposed in Japan in 1985.
- Perforating vessels nourish these flaps by penetrating fascia, muscle, or intermuscular septa.
- Various perforator flaps are utilized in lower extremity reconstruction, including posterior tibial, saphenous, peroneal, and malleolar island flaps.
Findings:
- Useful perforator flaps for lower extremity reconstruction include posterior tibial perforator island flaps, saphenous island flaps, peroneal island flaps, and malleolar island perforator flaps.
- Free flaps like the deep inferior epigastric perforator (DIEP) flap, anterolateral thigh (ALT) flap, and thoracodorsal artery perforator (TAP) flap are also described.
- These flaps are characterized by minimal donor-site morbidity, efficient dissection, and reliable skin coverage.
Implications:
- Perforator flaps represent an advancement in reconstructive surgery, offering improved outcomes.
- The understanding of perforator vascularity allows for more precise flap design and elevation.
- These techniques minimize tissue sacrifice at the donor site, enhancing patient recovery and function.