Ready to render for 3ds max 9 with vray all vray materials are included. The keystone perforator island flap elsevier australia. If there is a potential to harvest multiple perforator flaps from one vessel, the name of each flap should be based on its anatomical region or muscle. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated. The osu department of plastic surgery is pleased to announce. Initial descriptions of perforator flaps in 1989 by koshima and soeda, by using a musculocutaneous flap with an inferior epigastric arterybased skin island for reconstruction of defects involving the floor of mouth and groin, have led to significant additional advancements in the understanding of perforator flaps and vascular anatomy.
It requires selection of a suitable dominant perforator to support the flap and then retrograde intramuscular dissection of the perforator to the deep internal epigastric artery. A perforator flap should be named after the nutrient artery or vessels and not after the underlying muscle. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. Perforator flap perforator flap meeting 2017 columbus ohio. Perforator flaps in the hand bmc proceedings full text. The major reason for selecting this type of flap as compared to conventional musculocutaneous flaps is the reduction of morbidity at the donor site with the preservation of nerves and muscles. Overall, only 1516% of these mastectomy patients undergo reconstruction.
Adipo fascio cutaneous perforator based, shape modified. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Described by song 6, it is now widely considered an ideal soft tissue flap 7, with particular advantages in head and neck re construction providing a large, thin and pliable flap with. This results in an ellipse with its anterior longitudinal arc skirting the lateral border of the latissimus. This is a large series on clinical applications of the freestyle pedicled perforator flap. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. Our experience in lower limb reconstruction with perforator flaps jaume masia, md, phd, fabrizio moscatiello, md, gemma pons, md, manuel fernandez, fd, susana lopez, md, and pere serret, md abstraet. American perforator perforators perforating machines. Perforator based propeller flaps in limb reconstructive. All women who undergo mastectomy are candidates for consideration of perforator flap breast reconstruction when natural tissue reconstruction is preferred over implant reconstruction. Perforator variability in the anterolateral thigh free. Safety of single vein anastomosis versus double venous.
In addition, reports that describe flap use in burn care tend to focus on the reconstruction of postburn sequelae but do not address acute burn treatment. The perforator can be at the center, distal or proximal aspect of the flap, depending on the needed orientation in the recipient area. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites. However, experimental perforator flap models are limited. The recent introduction of chimeric sentinel muscle perforator flaps for freeflap monitoring, local perforator flaps for lower extremity reconstruction, and perforatortoperforator free flaps is simply the beginning. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Perforatorbased flaps for the treatment of burn scar. Lateral thoracic artery perforator flap can be easily dissect and harvest from dorsal skin with a consistent percentage of necrosis. Presentation pdf file perforator flaps have been used for last decade. Pedicle perforator flaps and keystone perforator island flaps are additional tools for reconstructive surgeons. Perforator flaps rose as an alternative to free tissue transfer in patients in whom the complications toll is high.
The flap dimensions needed are outline, with the perforator on the longitudinal axis of the flap. Presentation pdf file in this report, we present upper medial tigh perforator flap gracilis perforator flap in a hori zontal transverse to the gracilis muscle manner based on any reliable perforators from the upper medial thigh in four patient who have lower extremity soft tissue defects due to traumatic injuries. The impact of cta in preoperative planning of deep inferior. Others may be used as the situation dictates since all american perforators are made to special to order. Free fulltext pdf articles from hundreds of disciplines, all in one place functional mri to evaluate sense of self following perforator flap breast reconstruction pdf paperity toggle navigation. The free anterolateral thigh alt skin perforator flap has gained enormous popularity as a free skin perforator flap. Accordingly, the latissimus dorsi perforator flap signifies the perforator flap based on the musculocutaneous perforator, the thoracodorsal perforator flap is the perforator flap based on the septocutaneous perforator, and the lateral thoracic perforator flap is based on the direct cutaneous perforator from the lateral thoracic artery 10. The recent introduction of chimeric sentinel muscle perforator flaps for free flap monitoring, local perforator flaps for lower extremity reconstruction, and perforator to perforator free flaps is simply the beginning.
In this model the flap is harvested around a cutaneous perforator arterial branch by twisting of the vascular pedicle and rotating the skin paddle. The vascular anatomy of cutaneous perforators is of vital importance for. An assessment of the anatomical basis of the thoracoacromial. Amiens perforator flap conference in conjunction with the annual ruberg symposium. Perforator flaps for breast reconstruction download. Enhancing efficiency in abdominally based free flap breast reconstruction using ct angiography flap selection based on deep inferior epigastric perforator courses s. This results in an ellipse with its anterior longitudinal arc. Distal posterior tibial artery perforator flaps for the treatment of. In our insti tution the free alt perforator flap has become a work horse flap in head and neck reconstruction. During the evolution of surgical techniques from the pedicle trasverse rectus abdominis myocutaneous tram flap, to the free tram, to the musclesparing free tram, to dieap flap, there has been a constant battle between attempts to minimize morbidity to. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb and the trunk. This issue of clinics in plastic surgery provides guidance to help plastic surgeons incorporate perforator flap techniques in their practices. Feb 28, 2019 overall, only 1516% of these mastectomy patients undergo reconstruction. Described as a curvilinear shaped trapezoidal design flap, it fits well into body contours.
Apr 15, 2015 accordingly, the latissimus dorsi perforator flap signifies the perforator flap based on the musculocutaneous perforator, the thoracodorsal perforator flap is the perforator flap based on the septocutaneous perforator, and the lateral thoracic perforator flap is based on the direct cutaneous perforator from the lateral thoracic artery 10. A broad search was undertaken through the pubmed database using the terms anterolateral thigh free flap and perforator. Freestyle local perforator flaps for facial reconstruction. The anterolateral thigh alt free flap is frequently used in the head and neck.
Perforator variability in the anterolateral thigh free flap. The perforatorbased propeller flap is a versatile option in reconstructive surgery. Perforator definition of perforator by the free dictionary. Accompanying the book are four supplemental dvds that exhibit exact working procedures.
Keystone and pedicle perforator flaps in reconstructive. Single or double venous anastomosis in free flap in general and alt, in particular, is still a matter of debate between micro vascular surgeons. Jan 30, 2017 the anterolateral thigh alt free flap is frequently used in the head and neck. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. The versatility of the perforator flap makes it ideal for the reconstruction of threedimensional defects such as breast reconstruction or as a thin flap for resurfacing shallow wounds when bulk is considered a disadvantage. Application of chimerical alt perforator flap with vastus. A surgical technique for obtain ing propeller perforator flaps in the lower leg was described by teo 6 in 2010. The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will. B the flap was transferred with the distal capillary perforator. It shows the surgical dissection techniques of each flap step by step, from vascular anatomy, flap design and elevation to harvest and transfer. However, this study is the first to report on the application of the chimeric alt perforator flap with a muscle component after the radical resection of tongue cancer.
Step 3 the medial incision is made with cutting electrocautery and is carried through the subcutaneous fat down to the deep fascial layer overlying the rectus femoris muscle. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. Perforator local flaps in lower limb reconstruction. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb, and the trunk. Perforator flaps, an issue of clinics in plastic surgery. The use of perforator flaps today represents a safe and reliable procedure in reconstructive plastic surgery. Very high detailed and very accurate perforator model based on original cad drawing all part are separated can use for animation, presentation, ilustration etc. Basic research and micro anatomy for the next step in perforator flaps presenter. Pdf first metatarsal artery capillary perforator flaps. It yields a relatively long, thin and pliable skin flap and a. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. The anatomic basis of perforator flaps clinics in plastic surgery. The rats were randomly assigned to one of three groups.
Perforator flaps, anatomy, technique and clinical applications. References to any names, marks, products, or services of third parties or hypertext links to third. Can j plast surg vol 11 no 1 spring 2003 23 an assessment of the anatomical basis of the thoracoacromial artery perforator flap christopher robert geddes bsc, maolin tang md, daping yang md, steven f morris md, msc, frcsc department of anatomy, neurobiology and surgery, faculty of medicine, dalhousie university, halifax, nova scotia. Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options.
Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. Free tissue transfer to the lower extremity a paradigm shift in flap selection for soft tissue reconstruction rahim s. Profunda artery perforator pap flap for breast reconstruction. This low percentage has been attributed to lack of both information and access. It has been championed as an alternative to the tug flap. Free anterolateral thigh perforator flap for head and neck. Use of a skin perforator flap pedicled by the intercostal muscle for reconstruction of a posterior cervical defect. The application of taylors concept about body angiosomes, referred to tissue transfers, has meant that the development of the perforator flaps. Burn, scar, contracture, perforator flap background today, most patients will survive severe burn injuries, but they will. The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. Facial artery with its numerous small cutaneous perforators can be a source for freestyle skin flaps that can be islanded and have greater reach, one of which is nasolabial perforatory. Because of its many advantages and its versatility, the authors believe it. The pap flap for breast reconstruction was originated in 2010 by dr. The impact of cta in preoperative planning of deep.
Operating from the central idea that it is necessary to preserve the integrity of the dermatome with its innervation and vascularisation, the. A left, a 26yearold man with volar skin necrosis of the right second toe. However, in order to cover the defect, local perforator flaps are mobilized in a propeller, rotational, advancement, or transpositional. Nasolabial flap is a workhorse flap for coverage of many facial units. Functional mri to evaluate sense of self following. In this study, we will present our experience in single vein anastomosis versus double venous anastomosis in alt perforator flap used in leg and foot reconstruction as regarding flap outcome, complications, operation time and the need. We prefer a flap to be based on a single large perforator. Deep inferior epigastric perforator flap for breast. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the. Perforator flaps were first introduced in 1992 and were developed out of a desire to further mimimize donor site morbidity and possibly recovery time without compromising safety or aesthetic outcomes.
Two main algorithms are applied for reconstruction of. Use of a skin perforator flap pedicled by the intercostal. Utility and versatility of perforatorbased propeller. The above sample inscriptions, with or without a changeable 6digit date are commonly in use. Perforator article about perforator by the free dictionary. Free style perforator flaps for aesthetic facial reconstruction. The propeller flap represents a model of local perforator flap that was first described by hyakusoku et al. We described the experimental extended lateral thoracic artery perforator flap and standardized size of flap size. Facial artery with its numerous small cutaneous perforators can be a source for freestyle skin flaps that can be islanded and have greater reach, one of which is nasolabial perforatory flap.
The free anterolateral thigh alt skin perforator flap has gained enormous popularity as. Editor peter neligan, one of the worlds leading experts in perforator flaps, has assembled highly experienced authors to share. The flap is outlined along the axis, and the upper third of the flap is located over the cutaneous perforator. The profunda femoris artery supplies the tissue of the posterior thigh through musculo and septocutaneous perforators. The book outlines strategies for flap harvest, from in all probability probably the most main to the extraordinarily superior. Reconstruction of pelviperineal injuries with perforator flaps scielo. This international meeting usually held in amiens france is coming to the united states for the first time.
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