On a Hunt for the "True" Septocutaneous Perforator: A Histology Cross-Section Study

Area of Science:

• Anatomy
• Surgical Techniques
• Vascular Biology

Background:

• Free perforator flaps are crucial in reconstructive surgery for minimizing donor site morbidity.
• The anatomical course and nomenclature of perforator vessels present significant variability and confusion.
• This study investigates the precise pathway of septocutaneous perforators relative to fascial septa.

Purpose of the Study:

• To clarify the anatomical course of septocutaneous perforators.
• To determine if perforators traverse within or merely adhere to fascial septa.
• To provide guidance for safer surgical dissection techniques.

Main Methods:

• Examined 69 septocutaneous perforators from lateral arm, anterolateral thigh, and radial forearm flaps in 14 cadavers.
• Utilized gross examination, cross-sections, and histological analysis to assess vessel position relative to septal tissue.
• Investigated perforator pathways at multiple anatomical levels.

Main Results:

• 88.5% (61/69) of septocutaneous perforators were found to be adherent to the septum (paraseptal pathway).
• 12.5% (8/69) of perforators traversed within the septum (intraseptal pathway).
• Intraseptal perforators were identified across all three donor flap types studied.

Conclusions:

• Septocutaneous vessels exhibit both paraseptal and intraseptal pathways, distinguishable microscopically.
• The majority of these perforators follow a paraseptal course, adjacent to the septum.
• Dissection incorporating a portion of the septum is recommended to safeguard perforators during flap elevation.