Flap, combined with his similar colleagues to write the first book on just perforator flaps, published in 2006 22. Vascular anatomy ofthe integument of the head and neck steven f. Deqing hu this atlas is organized in a way with a combination of basic theory and clinical practices, and of real photos and text description in perforator flap. 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. It is not necessary to skeletonize the whole length of the pedicle. Conflicting and outdated guidelines mean that coding for diep flaps can be a challenge. The use of keystone island flaps for specific surgical specialities, including head and neck, melanoma, trauma including compound fractures of the lower limb and even irradiated tissue is also addressed. By composition, a perforator flap can be a fascioadipocutaneous flap or. Skin flaps can be classified simply as a direct or an indirect perforator flaps direct perforators. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply.
If youre looking for a free download links of perforator flaps. The exact definition of a perforator flap is not clear, and the terminology and the classification of the different perforator flaps have not yet been identified. Perforator flaps have evolved, and they have provided many new flaps with. Discuss flap physiology, including delay phenomenon and tissue expansion. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring. The concept of the perforator flap was introduced by kroll et al. 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 is done to fill a defect such as a wound resulting from injury or surgery when the.
Perforator flap definition of perforator flap by medical. Before we could come up with a clear definition of a perforator flap, it was important to define what a perforating vessel is. Ashton definition and nomenclature of propeller flaps. 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. Functional tongue reconstruction with the anterolateral thigh. Flaps and grafts in plastic surgery linkedin slideshare. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. A perforator flap is a flap consisting of skin and subcutaneous tissue that is perfused by an isolated artery.
Breast reconstruction with flap surgery mayo clinic. Perforator definition of perforator by the free dictionary. A machine that can bore a tunnel underground a perforating artery or vein. Nov 25, 20 perforator detection, dissection, and planning of the alt flaps were performed as described elsewhere 4,6,7. Hyakusoku 1991 coined the term propeller flap 17, although it wasnt until later that the hub providing flap circulation was found to be more versatile if. General surgeons will learn from the descriptions of the vascular basis for skin flaps and from the refined approach to how skin flaps should be. When a flap s blood supply depends on a septal perforator, this flap is called a septal perforator flap.
Perforator definition of perforator by medical dictionary. The keystone perforator island flap concept, 1e 1st edition pdf. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. According to the definition established during the consensus conference of gent in 2003, perforator flaps are constituted by cutaneous and subcutaneous tissue areas nourished by perforator arterial branches originating from major vascular bundles with an intramuscular or intraseptal course. The concept of the perforator is not new, but is an idea that evolved from the conventional flap. Perforator propeller flaps have a reliable vascular pedicle and can.
Inguinal flaps were conventional flaps harvested in textbook style, and. Other readers will always be interested in your opinion of the books youve read. Anatomy of the abdominal skin harvested with the diep flap. For example, thin perforator flaps from the inguinal region can be used.
If the pedicle is to be tunneled beneath the skin, for example in toe transfers where one tunnels beneath the dorsal hand skin to reach the recipient vessels in the snuff box or wrist, the vessels are dissected free. However, confusion has developed due to the erroneous belief that perforator flaps are different from conventional flaps. Nonmuscle perforator flaps, in particular neurocutaneous perforator flaps, are also discussed in this section. Newer applications for perforator flaps are being developed as this issue of seminars in plastic surgery is being published. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery.
The origin and the route the perforators followed have become less relevant and confusion has increased. Perforator a prehistoric tool in the form of a pointed stick made of wood or bone. On the basis of this definition we set out to revise all the current literature in order to individualize the first true perforator flap, and to catalog all the perforator flaps described up to now in the literature. 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. Atlas of perforator flap and wound healing springerlink. Distinguish the vascular anatomy of the skin, muscle, fascia, and perforator flaps. Perforator flaps for breast reconstruction download. Lastly, some brief information and examples of perforatorbased workhorse flaps are. The first ever international course on perforator flaps icpf was organized in gent, belgium, 20 years ago in 1997, when perforator flap surgery was still in its pioneering phase. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. As for lower limb, propeller flaps also permit reconstructing defects of different tissue with a single flap. A brief history of perforator flaps hallock journal of. The deep inferior epigastric artery perforator diep flap.
Perforator flap surgery is a technique used in reconstructive surgery where skin andor. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected. Pdf the term perforator flap, used to define a new type of flap, has. The upper portion is either thickened or shaped into a figure and sometimes has an opening for hanging. Integrate the concepts of angiosomes and venosomes and their effects on flap design. Definition, classification, and indications in the different body regions are.
Flaps and skin grafts text and atlas of wound diagnosis and. Much of the breast reconstruction using your bodys own tissue can be accomplished at the time of your mastectomy immediate reconstruction, though sometimes it can be done as a separate procedure later delayed reconstruction. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Geoffrey hallock is a plastic surgeon in allentown, pennsylvania. This has also caused a corresponding increase in the number of breast. First, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella, then the midpoint of this line was determined, because the dominant perforators supplying the flap are located within a circle. Perforator flaps have significantly contributed to a further reduction in donor sit morbidity when compared to myocutaneous or muscle flaps. The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. The introduction of perforator flaps represented a significant advance in microsurgical reconstruction. Hyakusoku 1991 coined the term propeller flap 17, although it wasnt until later that the hub providing flap circulation was found to be more versatile if relying on a. Whether youve loved the book or not, if you give your honest and detailed thoughts then people will find new books that are right for them. The keystone perforator island flap concept is an authoritative keystone flap textbook. Perforator flaps have been advocated to be another soft tissue choice for all zones of the lower extremity, recognizing that donor site function preservation is their major asset because in such perforator. The recent introduction of chimeric sentinel muscle perforator flaps for freeflap monitoring, local perforator flaps for lower extremity reconstruction, and perforator to perforator free flaps is simply the beginning.
Plastic surgery perforator flaps thieme medical publishers. Hallock division of plastic surgery, sacred heart hospital, allentown, pennsylvania, usa correspondence to. Allen has rejoined us in new york city to perform the highest level of perforator flap breast reconstruction with dr. Atlas of perforator flap and wound healing uk education. Perforator article about perforator by the free dictionary. Atlas of perforator flap and wound healing pdf libribook. Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon. Although the definition of perforators and perforator flaps is still somewhat controversial, it is generally. The same principle is followed in dissecting perforator flaps. Koshima, whom many consider the father of perforator flaps, in 1989 instead used periumbilical flaps based on deep inferior epigastric artery perforators. A brief history of perforator flaps hallock journal of xiangya.
He received his medical degree from sidney kimmel medical college and has been in practice for more than 20 years. The headcapsule, however, ruptures along two lateral longitudinal lines, thus. Surgical atlas of perforator flaps download ebook pdf. Perforator medical definition merriamwebster medical. On the right side of the abdomen, a large diep perforator through the rectus muscle is illustrated. Division of plastic surgery, sacred heart hospital. Clinical definition of independent myocutaneous vascular territories. Overview, classification, and nomenclature geoffrey g. Due to confusion about the definition and nomenclature of perforator flaps, a consensus meeting was held in gent, belgium, on september 29, 2001. Although the definition of perforators and perforator flaps is still somewhat controversial, it is generally accepted that a flap based on either a septocutaneous or musculocutaneous perforator can be called a perforator flap, whether the skin or only the subcutaneous fat or fascia is included. Sep 10, 2018 unlike other flaps used for breast reconstruction, deep inferior epigastric perforator diep flaps preserve muscle function at the donor site, improving the patients core strength and reducing the risk of hernia after surgery. Regarding the nomenclature of these flaps, the authors stated the following. The keystone perforator island flap concept, 1e 1st. A cost based comparison between perforator flaps and tram flaps for breast reconstruction may 2000 robert j.