Many surgical techniques including forearm flaps are available for the skin defect around the hand. The superior gluteal artery perforator flap has been popularized as an alternate free flap in breast reconstruction for patients with insufficient abdominal tissue or for patients who are not candidates for deep inferior epigastric perforator flap reconstruction ie, those with prior abdominal surgery 23 25. What started as a small meeting among friends, has grown into a major international forum where colleagues share their new ideas in the field of perforator. Therefore, perforators can not be completely distinguished from the conventional flaps and some classical flaps. Musclesparing perforator free flap breast reconstruction with the use of an inferior epigastric or gluteal perforating artery to create a vascular pedicle is increasingly popular because it obviates breast implants and results in lower donor site morbidity than breast reconstruction with myocutaneous flaps. Perforator flap surgery is a technique used in reconstructive surgery where skin andor. 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. Modern anatomical understanding, good planning, and meticulous surgical technique can affect clinical results. Key topics two days of b2c breakfasttococktail sessions encompass all the cutting edge aspects of technologyrich perforator surgery including functional reconstruction, lymphedema, targeted muscle reinnervation tmr, biologic, imaging, flap monitoring and emerging technology. Perforator flaps are described according to the main artery of origin e. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. Suffix s is added if the flap is harvested based on direct septal or fasciocutaneous vessels. Modern perforator flap imaging with highresolution blood.
Management of large sternal wound infections with the. If youre looking for a free download links of perforator flaps. Perforator flap is better option for sacral pressure ulcer. Free style perforator flaps for aesthetic facial reconstruction. The computeraided design cad files and all associated content posted to this website are created, uploaded, managed and owned by third party users. Use of the thoracodorsal artery perforator flap for bronchial. The management of sternal wound infections often requires pedicled flaps. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. A new operative technique for dissecting perforator vessel in. 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. The handheld doppler device was used to localize potential perforators for a propeller flap in close proximity to the defect.
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. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites. The gluteal artery perforator flap can be designed to recruit adipose tissue from either the upper superior gluteal artery perforator sgap flap18,2225 or lower inferior gluteal artery perforator flap buttock. The editors, leading reconstructive surgeons and pioneers in the field of perforator flap surgery, have assembled a group of worldrenowned experts who discuss perforator anatomy and clinical indications for the use of these flaps. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. 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. Impact of internal mammary artery perforator propeller flap. The history of evolution something new is something old that has been forgotten. Surgical atlas of perforator flaps pdf free download. Impact of internal mammary artery perforator propeller. Fasciocutaneous propeller flap based on perforating. Pdf chest wall perforator flaps for partial breast.
The facial artery, the biggest perforator vessel of the body presenters. In our practice, this flap has replaced the traditional. Patil, jayaprasad, sharma, and sharma 2012 reconstructed a similar defect of the foot using the gracilis tendon as a graft for replacing the extensor tendons, adding a free gracilis muscle flap, and a split. Anatomic imaging of abdominal perforator flaps without. Nov 21, 2019 fingertip amputations are a very common form of injury seen in the emergency departments. Ct angiography of inferior epigastric and gluteal perforating. 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 diep flap requires. Use of the thoracodorsal artery perforator flap for. The fasciocutaneous iliotibial band perforator flap in. The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. The perforator can be at the center, distal or proximal aspect of the flap, depending on the needed orientation in the recipient area.
The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will. 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. Debrotwir, and warren matthew rozen 2014 reducing radiation dose without compromising image quality in preoperative perforator flap imaging with cta using asir technology. In 16 patients with small soft tissue defects on the upper and lower extremities, perforatorbased propeller flaps were planned. We present our experience with 10 cases of unilateral vy flaps raised on a perforator vessel and advanced in a. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites. Perforator definition of perforator by the free dictionary. Various techniques have been described for the management of these injuries including simple dressings, skin grafts, homodigital, heterodigital and regional flaps and also free flaps.
The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. All patients who underwent a completion pneumonectomy with reinforcement of bronchial stump with a tdap flap from december 2009 to october 2010 were followed prospectively. The term perforator flap, used to define a new type of flap, has recently been introduced in the medical field and in the clinical practice of plastic surgeons. Perforator flaps in the hand bmc proceedings full text. A perforating vessel, or, in short, a perforator, is a vessel that has its origin in one of the axial vessels of the body. The microvascular peroneal artery perforator flap as a.
Anatomic imaging of abdominal perforator flaps without ionizing radiation. For perforator analysis, the user identifies a reference point e. Fingertip amputations are a very common form of injury seen in the emergency departments. Perforator flaps in head and neck surgery sciencedirect. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. Patient demand for perforator flap procedures is quickly growing due to positive results. A perforator flap is a flap of skin or subcutaneous tissue that is based on the dissection of a perforating vessel 42. Through their experience with 144 patients, the authors evaluate the use of the free opensource dicom viewer osirix for mac in the preoperative planning of perforator flaps with three objectives.
This study is focused on a particular perforator lateral to the angle of the mouth. Pdf on apr 18, 2018, goktekin tenekeci and others published perforator flaps. The use of gluteal perforator flap from gluteal vessels is also spreading for the resurfacing sacral pressure ulcer. Seeing is believing with magnetic resonance imaging angiography david greenspun, julie vasile, joshua l. Between january 2012 and december 2018, we enrolled 25 patients who underwent internal mammary artery perforator imap flap reconstruction after salvage tl or lp. It shows the surgical dissection techniques of each flap step by step, from vascular anatomy, flap design and elevation to harvest and transfer. Flap was raised on one or two perforators and was rotated to 180. Principles and techniques find, read and cite all the research you need on. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring. The distallybased island ulnar artery perforator flap for wrist defects. Chest wall perforator flaps for partial breast reconstruction in breast cancer poster pdf available in european journal of surgical oncology 446. Jan 17, 2017 automatic perforator reporting software was implemented as an osirix digital imaging and communications in medicine dicom viewer plugin. Computed tomography angiography, perforator flaps, the.
A limitation of the iltb perforator flap is the short vascular pedicle. 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. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. Newer applications for perforator flaps are being developed as this issue of seminars in plastic surgery is being published. A machine that can bore a tunnel underground a perforating artery or vein. Instead, names such as the superficial circumflex iliac perforator flap, superficial inferior epigastric perforator flap, or external pudendal perforator flap were used fig. Thieme ebooks, the first edition of perforator flaps. Automatic perforator reporting software was implemented as an osirix digital imaging and communications in medicine dicom viewer plugin. Apr 15, 2015 therefore, the term, groin flap was not commonly used. For sternal wounds, the superior epigastric artery perforator seap flap can be used with the propeller procedure with minimal donor site morbidity.
Posterior tibial arterybased perforator flaps were used in five cases and peroneal arterybased perforator flaps in three cases. Distally based perforator sural flaps for foot and ankle. Before the development of the perforator concept, the method of dissection of an inguinal. Stacked deep inferior epigastric perforator flap breast reconstruction. Levine, heather erhard, rebecca studinger, victoria chernyak, tiffany newman, martin prince, robert j. The pap and accompanying veins arise from deep within the thigh and run posteromedially, providing blood flow to the upper medial and posterior thigh. 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 diep flap requires breast plastic and reconstructive surgeons at johns hopkins medicine also. The fasciocutaneous iliotibial band perforator flap in soft. Pdf the term perforator flap, used to define a new type of flap, has recently. Perforators of the proximal peroneal artery were also marked to allow conversion to. The microvascular peroneal artery perforator flap as a life. The book outlines techniques for flap harvest, from the most basic to the highly advanced. A cohort case series of 14 modiolus perforator flap reconstructions in 14 patients and a color doppler ultrasonography. The impact of cta in preoperative planning of deep.
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. As for lower limb, propeller flaps also permit reconstructing defects of different tissue with a single flap. The size of the vessels was adequate for anastomosis in this. Perforator pedicle flaps are largely replacing the concept of random flaps in our practice, and for the past 8 years, freestyle perforator flaps have been our first choice local flap for facial reconstruction. Chimeric stacked deep inferior epigastric perforator flap breast reconstruction. This results in an ellipse with its anterior longitudinal arc. We present our experience with 10 cases of unilateral vy flaps raised on a perforator vessel and advanced in a modified. Perforator flap versus conventional flap journal of korean medical. The muscle is large, and runs parallel, posteror and deep to the gracilis muscle. Keystone and pedicle perforator flaps in reconstructive. The flap dimensions needed are outline, with the perforator on the longitudinal axis of the flap. Reducing radiation dose without compromising image quality.
Reducing radiation dose without compromising image quality in. In 16 patients with small soft tissue defects on the upper and lower extremities, perforator based propeller flaps were planned. Perforator flap perforator flap meeting 2017 columbus ohio. 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. The fasciocutaneous iltb perforator flap offers the same advantages of the alt. This results in an ellipse with its anterior longitudinal arc skirting the lateral border of the latissimus. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected. Perforator flaps for breast reconstruction gives plastic surgeons the detailed instructions they need to perform these sophisticated breast reconstruction procedures. Freestyle local perforator flaps for facial reconstruction. Distally based perforator sural flaps for foot and ankle reconstruction shimin chang, xiaohua li, yudong gu shimin chang, xiaohua li, department of orthopedic. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring defects throughout the body. Perforator flap definition of perforator flap by medical.
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. Surgical atlas of perforator flaps a microsurgical dissection. The lcf perforator flap is now included in both concepts and it is a perforator flap. The perforator for the pap flap travels through the adductor magnus muscle. Suffix ap artery perforator signifies a true musculocutaneous perforator flap. In recent years, the development of perforator flap surgery has increased the number of potential donor sites, because this type of flap can be supplied by any cutaneous perforator and donor site morbidity can be reduced. The thoracodorsal artery perforator flap tdap flap allows raising the same cutaneous island as in the classical latissimus dorsi musculocutaneous flap without its muscular part. Find, read and cite all the research you need on researchgate. Therefore, the term, groin flap was not commonly used. Load in 3d viewer uploaded by anonymous pdf medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap. Perforator exploded view 3d cad model library grabcad.
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