Perforator flaps

[1] The vessels that supply blood to the flap are isolated perforator(s) derived from a deep vascular system through the underlying muscle or intermuscular septa.

[1] Soft tissue defects due to trauma or after tumor extirpation are important medical and cosmetic topics.

[citation needed] Musculocutaneous perforators supply the overlying skin by traversing through muscle before they pierce the deep fascia.

[1] Septocutaneous perforators supply the overlying skin by traversing through an intermuscular septum before they pierce the deep fascia.

[1] Due to confusion about the definition and nomenclature of perforator flaps, a consensus meeting was held in Gent, Belgium, on September 29, 2001.

[1] This so-called 'gent consensus' was needed because the lack of definitions and standard rules on terminology created confusion in communication between surgeons.

[11] When a surgeon uses a free flap, the blood supply is cut and the pedicle reattached to recipient vessels, performing a microsurgical anastomosis.

[citation needed] This type of transfer is also called "advancement".The surgeon disconnects the flap from the body, except for the perforators.

It is important that the type of nourishing pedicle, the degree of skin island rotation and, when possible, the artery of origin of the perforator vessel are mentioned.

The choice of the type of tissue transposition depends on the location, nature, extent and status of the deformity.

Due to the development and improvement of cutaneous, myocutanous and fasciocutaneous tissue transpositions plastic surgeons are able to successfully restore the defect to its original shape.

In the case of using a so-called perforator flap, a reliable vascularization and the possibility of sensory (re) innervation can be combined with less donor-site morbidity and limited loss of function in the donor area.

[17] When taking breast reconstruction into consideration, several surgical options are available to achieve lasting natural results with decreased donor-site deformities.

The broad option of donor-sites makes practically all patients candidates for autogenous perforator flap reconstruction.

[18] If there is extensive destruction a fasciotomy is needed, therefore it is generally accepted that the best way to cover these types of tissue defects is a free flap transplantation.

[17] Furthermore, patients have shown decreased postoperative pain and accelerated rehabilitation [17][25] Nevertheless, there will always be a chance that the displaced tissue partially or completely dies considering the fact that the perfusion of the flap is difficult to assess intraoperatively.

Thus considering the complexity and length of this procedure microsurgical expertise is required and patients need to undergo a longer period of anesthetics that of course could result in increased risk factors.

[29] Indications: Contraindications:[30][31] Associated with the patient: Any condition that probably increases the risk of intraoperative or postoperative complications:[32] By inducing thrombogenic state through vasoconstriction of the microvasculature, tobacco influences blood flow, wound healing and the survival of pedicled flaps.