2018
DOI: 10.1097/prs.0000000000004698
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Pure Skin Perforator Flaps: The Anatomical Vascularity of the Superthin Flap

Abstract: The location number of the pure skin perforators within the flap was not considered to be a crucial factor in the flap design and size in this study. This new knowledge regarding the pure skin perforator concept will allow surgeons to elevate a full-thickness skin flap safely.

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Cited by 52 publications
(29 citation statements)
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“…Narushima used ICG angiography during flap surgeries and proposed the pure skin perforator concept in 2018. 20 They described that the pure skin perforator flap can be elevated based on branches of the perforating artery directly supplying blood to the deep dermal layer. They reported that branches of pure skin perforators formed intradermal anastomoses with the adjacent pure skin perforator territory and allowed safe expansion of the flap to the adjacent territory.…”
Section: Arterial Systemmentioning
confidence: 99%
“…Narushima used ICG angiography during flap surgeries and proposed the pure skin perforator concept in 2018. 20 They described that the pure skin perforator flap can be elevated based on branches of the perforating artery directly supplying blood to the deep dermal layer. They reported that branches of pure skin perforators formed intradermal anastomoses with the adjacent pure skin perforator territory and allowed safe expansion of the flap to the adjacent territory.…”
Section: Arterial Systemmentioning
confidence: 99%
“…49 Narushima et al demonstrated that the subdermal and dermal vascular networks are able to supply skin perfusion in a PSP flap, providing the basis for reappraisal of the microvascular anatomy for thin and superthin flaps. 37 However, limited knowledge of perforasomes of such flaps means further dedicated works are required and thus intraoperative indocyanine green should always be performed intraoperatively to assess the flap vascularity.…”
Section: Designing Alt Flap Using Ultrasoundmentioning
confidence: 99%
“…As we can see, the evolution shows that soft tissue free flaps have become thinner as they are raised in a more superficial plane of dissection. This has been possible due to new technologies such a Computed Tomographic Angiography (CTA) and high-frequency ultrasound 7 as well as a deeper knowledge in vascular anatomy such as the perforasome theory described by Saint-Cyr et al 8 Narushima et al 9 proposed a classification of thin flaps based on the anatomical plane on which they are raised: thin flaps dissected in the plane of the superficial adipose fascia, super thin flaps going above the superficial fascia, full thickness skin flap or pure skin perforator (PSP) flaps that are only as thick as the dermis and its superficial plexus of vessels, and split thickness skin flaps.…”
Section: In 1981mentioning
confidence: 99%