Pure Skin Perforator Flaps: The Anatomical Vascularity of the Superthin Flap

Narushima, Mitsunaga; Yamasoba, Tatsuya; Iida, Takuya; Matsumoto, Yu; Yamamoto, Takumi; Yoshimatsu, Hironobu; Timothy, Shim; Pafitanis, Georgios; Yamashita, Shuji; Koshima, Isao

doi:10.1097/prs.0000000000004698

Cited by 52 publications

(29 citation statements)

References 17 publications

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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%

Evolution of Anatomical Studies on the Arterial, Venous, and Lymphatic System in Plastic Surgery

et al. 2022

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Anatomies of the vascular and lymphatic systems have been vital research topics in reconstructive surgery. Harvey was a pioneer who provided the earliest descriptions of the cutaneous vasculature in the 17th century. The concept of vascular territories of the skin was first described by Manchot. The radiographic injection method in cadavers was developed by Salman, who defined more than 80 vascular territories. The arterial system has been thoroughly investigated with the development of regional and free flaps. The concept of axial and random pattern flaps was introduced by McGregor and Morgan. Manchot's vascular territories were refined by Taylor and Palmer as the angiosome concept. Detailed information about the venous circulation is essential for reconstructive surgeries. The concept of intrinsic and extrinsic venocutaneous vascular systems was introduced by Nakajima and led to the development of the venoadipofascial flap. The importance of venous augmentation in flap survival was emphasized by Chang. The lymphatic system was discovered much later than the arterial and venous systems. Aselli was credited for discovering the lacteal vessels in the 17th century; mercury was popularly used as a contrast agent to distinguish lymphatic vessels for the next three centuries. A radiographic method in cadavers was developed by Suami. Lymphatic imaging devices are constantly upgrading, and photoacoustic imaging was recently introduced for three-dimensional visualization of architecture of superficial layers of the lymphatic and venous systems.

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Section: Arterial Systemmentioning

confidence: 99%

Evolution of Anatomical Studies on the Arterial, Venous, and Lymphatic System in Plastic Surgery

et al. 2022

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“…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%

Designing An Anterolateral Thigh Flap Using Ultrasound

Visconti

Bianchi

Hayashi

et al. 2021

J Reconstr Microsurg

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Background Preoperative knowledge of themicrovascular anatomy of a patientmay improve safetyand efficacy and reduce morbidity. Today, with the advancement in technology, ultrasound can provide minute details of the structures within the body, which makes this technology very helpful in preoperative evaluation of the traditional perforator flaps as well as thin, superthin, and pure skin perforator flaps. Methods In this article, we will describe the design of one of the most popular perforator flaps, the anterolateral thigh (ALT) flap, using high-frequency and ultrahigh-frequency ultrasound technology. Results Ultrasound technology allows to study preoperatively the ALT donor-site and its microvascular anatomy by using different US modalities in order to provide a virtual surgical plan to the operating surgeon. Conclusion Ultrasound technology allow to expand preoperative knowledge of flap microvascular anatomy and its course within the subcutaneous tissue up to and within the dermis, allowing to select the best perforator for the given reconstruction and the plane of elevation for thin, superthin and pure skin perforator flap.

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“…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%

Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

Ríos

Falguera-Uceda

Ferrer

et al. 2021

Craniomaxillofacial Trauma & Reconstruction Open

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Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

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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.

Cited by 52 publications

References 17 publications

Evolution of Anatomical Studies on the Arterial, Venous, and Lymphatic System in Plastic Surgery

Evolution of Anatomical Studies on the Arterial, Venous, and Lymphatic System in Plastic Surgery

Designing An Anterolateral Thigh Flap Using Ultrasound

Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

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