J Korean Med Assoc.  2014 Aug;57(8):695-703. 10.5124/jkma.2014.57.8.695.

Concept of perforator flap and reconstruction using microsurgery

• Kim JT
• Kim SW

• KMID: 2194920
• DOI: http://doi.org/10.5124/jkma.2014.57.8.695

Abstract

Free tissue transfer has revolutionized tissue reconstruction. Microvascular operation techniques using free tissue transfer make it possible to precisely restore various defects and deformities. There are various surgical flaps available for this surgery, such as muscle flaps, musculocutaneous flaps, or fasciocutaneous flaps. The development of perforator flaps enables multi-component reconstruction with reduced donor site morbidity. Successful reconstruction must be approached with the goals of not only providing stable coverage, but most importantly, of restoring function. Therefore, the selection of flaps is dependent on the recipient site characteristics and the functional and aesthetic results at both the recipient and donor sites. With the high success rate of free flaps and the popularization of the perforator flap, microvascular surgery has played a major role in various reconstructive fields.

Keyword

Perforator flap; Reconstruction; Microsurgery; Free tissue flaps

MeSH Terms

Congenital Abnormalities
Free Tissue Flaps
Humans
Microsurgery*
Myocutaneous Flap
Perforator Flap*
Surgical Flaps
Tissue Donors

Figure

• 

  Figure 1 (A) A 49-year-old male patient who was involved in a traffic accident, resulting in large skin defect in the lower leg with uncovered tibia and fibula fracture sites. (B) The infected lower leg was radically debrided and a negative pressure dressing was applied for 2 weeks. (C) A latissimus dorsi chimeric flap was harvested to reconstruct both medial and lateral defects of lower leg. (D) As the second stage operation, fibular flap was harvested for the reconstruction of tibia. (E) Six months after the operation, the extensive lower leg defect was successfully reconstructed.

• 

  Figure 2 (A) A 48-year-old male had crushing injury of hand, resulting third degree burn involving skin and soft tissue of hand dorsum. (B) Emergent surgery was performed. After radical debridement, anterolateral thigh perforator flap was harvested to reconstruct the defect. (C) Six month after the surgery. Division procedure of fingers was performed.

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  Figure 3 (A) A 73-year-old male patient had suffered hypopharyngeal cancer. (B,C) A 16×8 cm and 7×4 cm lateral thoracic perforator flap was harvested in chimeric pattern for cervical esophageal reconstruction. (D) Customized insetting of tubed lateral thoracic perforator flap and latissimus dorsi skin flap for simultaneous esophageal reconstruction and monitoring flap. (E) Esophagogram showed a good passage in a new conduit of tubed flap after the reconstruction. (F) Postoperative endoscopic view shows successful reconstruction of esophagus. (G) Postoperative view shows successful reconstruction of esophagus and outer resurfacing.

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  Figure 4 (A,B) A 22-year-old female with depressive deformity of forehead due to frontal sinusitis after traffic accident. (C,D) Intraoperative view of thoracodorsal perforator flap of adipomyofascial component. (E,F) Two years after the surgery. Depressive deformity was successfully reconstructed and the patient was satisfied with aesthetic result. Informed consent was received from the patient.

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  Figure 5 (A,B) A 44-year-old female had total mastectomy 5 years ago. (C) Deep inferior epigastric perforator flap was elevated. (D,E) Six month after the surgery, nipple-areolar complex was reconstructed and tattooed.

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  Figure 6 (A) A 27-year-old female had a traffic accident. The car ran over the foot, resulting in skin defect. (B) The pattern of the defect was copied. (C,D) Thin thoracodorsal perforator flap was elevated according to the pattern of the defect for tailored reconstruction. (E,F) Two years after the surgery, the patient was able to wear same size shoes and walk normally.

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