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The perforasome theory: vascular anatomy and clinical implications
Michel Saint-Cyr1, Corrine Wong, Mark Schaverien
1Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plastic and Reconstructive Surgery
|December 17, 2009
Summary
Understanding the vascular territory of perforators, termed perforasomes, is crucial for flap design. This study reveals complex, interconnected perforasome networks essential for flap perfusion.
Area of Science:
- Anatomy
- Vascular Surgery
- Microsurgery
Background:
- Understanding perforator vascular anatomy is vital for flap design and harvest.
- The study investigates the three-dimensional and four-dimensional arterial vascular territory of individual perforators (perforasomes).
Purpose of the Study:
- To elucidate the complex vascular anatomy and territory of single perforators (perforasomes).
- To assess the role of perforasomes in flap design and perfusion.
Main Methods:
- Anatomical study on 40 fresh cadavers, dissecting 217 flaps and perforasomes.
- Utilized 3D and 4D computed tomographic angiography for detailed vascular assessment.
- Investigated perforator flaps on the trunk and extremities, including subdermal plexus and fascial contributions.
Main Results:
- Perforator vascular territories (perforasomes) are complex and variable.
- Adjacent perforasomes are interconnected via direct and indirect linking vessels.
- Vascular flow patterns are influenced by proximity to articulations and trunk locations.
Conclusions:
- Each perforator defines a unique vascular territory (perforasome).
- Perforator vascular supply is complex but follows general principles.
- Linking vessels are critical for flap perfusion, with all significant perforators viable for pedicle or free flaps.
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