The anatomic basis of perforator flaps

The recent enthusiasm for perforator flaps underlines the need for a detailed understanding of the cutaneous vasculature. The principle determinant of success in perforator flap surgery is the inclusion of an adequately sized cutaneous perforator in the flap. Therefore, the size, distribution, and variability of cutaneous perforators of the human body are crucial to the design and execution of successful perforator flap surgery. Based on numerous anatomic studies, the authors have found that the main source arteries supplying the skin are fairly constant but the individual cutaneous perforators are quite variable. Knowledge of the overall architecture of the vasculature and an awareness of the variability, combined with a flexible operative plan, will enable the perforator flap surgeon to take advantage of the most appropriate perforators to execute a successful operative plan.