Why Is the Perforator Flap Opaque? Consideration From the Perspective of Tissue Composition Based on a New Skin Flap...

Area of Science:

• Plastic Surgery
• Anatomy
• Surgical Classification

Background:

• Perforator flaps are clinically significant in flap surgery.
• Current terminology and definitions for perforator flaps lack clarity and consistency.
• Ambiguity in classification hinders standardized understanding and application.

Purpose of the Study:

• To resolve ambiguity surrounding perforator flap terminology and definition.
• To present a new classification system for skin flaps based on vascular plexus and tissue composition.
• To determine if perforator flaps constitute an independent category based on tissue composition.

Main Methods:

• Logical analysis of perforator flaps.
• Anatomical and physiological examinations.
• Development of a new classification system for skin flaps based on previously clarified vascular plexus and tissue composition.

Main Results:

• Identified 7 distinct skin flap types: full-thickness, split-thickness, thin (super-thin, pure skin), dermis, adipofascial, protective adipofascial, and lubricant adipofascial.
• Perforator flaps, excluding the pure skin subtype, do not possess exclusive tissue compositions.
• Perforator flaps cannot be classified as a distinct category solely based on tissue structure.

Conclusions:

• Rethinking flap classification requires consideration of objective anatomical features like tissue composition and vascular connectivity, not just surgical technique.
• The proposed classification system aims to homogenize terminology and the conceptual framework of skin flap surgery.
• Clarification of perforator flap classification enhances understanding and application in reconstructive surgery.