Perforator Flaps in Lower Extremity Reconstruction

Abstract

Perforator flaps are defined as skin flap without fascia or muscle and they are nourished by one or more perforating vessels perforating the fascia, muscle, or intermuscular septum. As early as 1985 in Japan, we proposed this concept over that of the fasciocutaneous flap, which was believed to be nourished by fascial plexus. The pedicle perforators are classified as septocutaneous, muscular (intermuscular), periosteal, and intertendinous perforators. As useful perforator flaps in the lower extremity, posterior tibial perforator island flaps, saphenous island flaps, peroneal island flaps, malleolar island perforator flaps, deep inferior epigastric perforator free flap (DIEP flap), anterolateral thigh free flap (ALT flap), and latissimus dorsi muscle free perforator flap (thoracodorsal artery perforator flap, T-DAP or TAP flap) were described. These flaps have the advantage of minimal donor-site morbidity, relatively rapid dissection and flap elevation, and reliable skin territory.

Microsurgical nonmicrovascular flaps in forearm and hand reconstruction

“…29,40 Because the main source of the blood supply for the skin comes from the subcutaneous arterial network 11,13,18,43 and not through the fascial vessels, 34,45 a true perforator flap is considered to be a flap consisting of skin and/or subcutaneous tissue. 3,27,51 So, considering this definition and the fact that the skin blood supply is mainly through direct septocutaneous perforators, 27 it would mean that the perforator flaps should only be cutaneous flaps, the inclusion of fascia being not mandatory. 34,45 However, there are some discussions regarding the inclusion of fascia; it is indeed well known that the richest network of arterial skin perfusion is in the subcutaneous tissue but, in the same time, it is also well known that the main anastomoses between perforators are found in the superficial layer of the deep fascia, where they form rich vascular arches, with longitudinal anastomoses.…”

Propellar flap: safe, reliable option for coverage of exposed tendo achilles

“…Various flaps have been described including the inferiorly based pedicled flap, reverse sural flap, islanded pedicled flaps, perforator flaps, propeller flaps and free flaps. [3][4][5][6][7][8][9][10][11]22 Free flaps are suitable for more extensive trauma, major avulsions and long defects, the procedure needs advanced skills, instrumentation, equipment and prolonged operating time. For moderate sized defects and majority of cases local flaps serve the purpose.…”

“…Various flaps have been described in literature for cover over TA like distally based skin flaps, advancement flap, free tissue transfers and islanded flaps. [3][4][5][6][7][8][9][10][11] The advent of islanded propeller flaps has changed the approach to reconstruction in general. Presence of abundance of perforators in the lower third of the leg arising from the posterior tibial and peroneal vessels is well documented.…”

Uso De Doble Colgajo Diep Para Reconstrucción De Extremidad Inferior

“…El uso de colgajos basados en perforantes y del DIEP en particular, es menos habitual muchas veces por el abultamiento que produce en un lugar donde se requiere de coberturas cutáneas más finas, sin embargo, ha sido comunicado su utilización con éxito en diferentes sitios, tales como extremidades superiores e inferiores [11][12][13][14][15][16] . En este caso, dado las condiciones generales y locales de la paciente este colgajo resultó ser una excelente alternativa, sin morbilidad en la zona dadora y un resultado adecuado.…”