Profunda artery perforator pap flap for breast reconstruction. Peroneal artery perforator flap for the treatment of chronic lower. The size, number, and location of perforators were recorded intraoperatively. Learn about the radial artery perforator fascial flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. A skin flap from the medial leg based on the posterior tibial artery and its cutaneous branches was first described by zhang and colleagues in 1983 1. Extensive clinical experi ence has since confirmed that perforator flaps are safe and reliable in. Figure 6 a a 22yearold male presented with a left foot degloving. The advantages of using this pedicled flap for hand reconstruction are numerous. 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.
The advantage of the lsap flap is that the lateral sural cutaneous nerve can be included to make this also a sensate flap. Initially, we used the superior gluteal artery perforator sgap flap. The thoracodorsal artery perforator flap has attracted great interest because its distinct advantages including a long donor vessel that can reach a recipient vessel far from traumatized or. The flap was transposed onto the breast anterolateral and posterolateral chest wall. To overcome this drawback the authors describe a technique of free transfer of the flap with preservation of the radial artery. The other is the superficial arteriolar system, which is the terminal. Hallock, md1 1division of plastic surgery, sacred heart and the lehigh valley. The reverseflow radial forearm chinese island flap is based on a distal vascular pedicle consisting of the radial artery and its venae comitantes. One is the main perforator arising from the digital artery that nourishes a wide, large flap, as in the patient in case 2 4 2 cm. We report our series of five adipofascial radial artery perforator flaps for the upper extremity.
Deep inferior epigastric perforator flap reconstruction. This study aimed to delineate and compare the hot spots and threedimensional vascular territories of dominant profunda artery perforators in the posterior thigh region, and modifications in flap design are discussed. This is not the extensive transposition seen with the musculocutaneous flap, because the radius of the thoracodorsal artery perforator arc is. Application of posterior thigh threedimensional profunda artery perforator perforasomes in refining nextgeneration flap designs. Recent advances in our understanding of the arterial basis of flap perfusion have led to more refined. If you have any other questions that the leaflet does not answer or would like a further explanation, please ask your surgeon or cns. An artery with its origin in the deep artery of the thigh, with distribution as three or four vessels that pass through the great adductor muscle to the posterior and lateral parts of the thigh. To reduce donor site morbidity in anterior chest wall reconstruction, a flap based on perforators of the superior epigastric artery sea was developed and successfully applied in a pedicled fashion for locoregional softtissue reconstruction. The pedicled perforator flaps commonly used for breast or thoracic reconstruction are the tdap flap, the intercostal artery perforator icap flap, and the serratus anterior artery perforator saap flap. The authors present an alternative source using posterior thigh soft tissue based on profunda artery perforators, termed the profunda artery perforator flap. The gluteal artery perforator flap was first introduced by our group in 1993.
The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. For raising a flap based on the posterior tibial artery perforator, the patient is placed in a supine position and the leg is slightly abducted and externally rotated. A new operative technique for dissecting perforator vessel in. It has been championed as an alternative to the tug flap. The versatility of the intercostal artery perforator icap. All of flaps were completely survived except one flap had partial flap necrosis. The thin, pliable and preservation of the radial and ulnar artery make the adipofascial perforator flap the ideal flap for the upper extremity. This perforator flap is typically based on the proximal perforator of the.
The superior and inferior gluteal artery perforator flaps have been used clinically, yet the published anatomical studies describing the blood supply to the gluteal skin are inadequate. The type of flaps used for these defects were based on perforators of the facial artery subsystem and were classified in this case series to those below the jawline level i with submental artery perforator smap and facial artery perforator flaps fapf, between the jawline and the nasal alae level ii with fapf flaps or superior labial artery perforator slap flaps and finally, flaps. Digital artery perforator flaps for fingertip reconstructions. Perforator flaps have provided freedom of flap design with over 350. The skin paddle design was based on distal perforators catching a surface area of 8.
Perforator patterns of the ulnar artery perforator flap. Application of posterior thigh threedimensional profunda. Common indications for flap coverage of the elbow and forearm are listed in box 1. A sensate lateral sural artery muscle perforator flap. The most frequently used perforator flaps nowadays are the deep inferior epigastric perforator flap, and both the superior and inferior gluteal sgap igap flap, all three mainly used for breast reconstruction. Sometimes, a segment of ld muscle may need to be included in the flap due to anatomical variations. Transverse, vertical, and sshaped profunda artery perforator flaps. Above, right the thoracodorsal artery perforator flap offers an arc of 90 degrees clockwise and counterclockwise.
It yields a relatively long, thin and pliable skin flap and a good aesthetic result. Chang performed an anatomic study in 1990 to show that the pivot point of the pedicle was located 1. Perforator propeller flaps have a reliable vascular pedicle and can undergo wide mobilization and rotation. This pdf is available for free download from a site hosted by medknow publications. The aim of this work was to study and evaluate the role of thoracodorsal artery perforator flap in breast reconstruction as regard indications, contraindications, advantages and. Anterior tibial artery perforator flap plastic surgery key.
The anatomy of the thoracodorsal artery in perforator flap. Breast reconstruction with gluteal artery perforator flaps. Lateral intercostal artery perforator licap flap breast reconstruction is suitable for some patients whose breast cancer is in the outer part of the breast. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. The versatility of profunda femoral artery perforator flap for. Is an excellent option in patients with surgical contraindications to abdominal tissue transfer previous abdominoplasty, thinness or. Lateral flap of the thigh based upon the lateral superior. The procedure aims to replace the lost breast tissue removed at the time of cancer surgery with skin and fat from under your arms and restore the size and shape of your breast. The deep inferior epigastric artery perforator flap dieap. Nov 07, 2017 this video demonstrates the propellar flap based on the perforators of posterior tibial artery for medial malleolar defect.
In this article, the authors describe a true ulnar artery perforator flap with perforator mapping. The versatile clinical use of the intercostal artery perforator. The superior and inferior gluteal artery perforator flaps. This study comprehensively evaluated the anatomical basis of these flaps to present anatomical landmarks to facilitate flap dissection. Radial artery perforator adipofascial flap interposition. The intercostal artery perforator icap flap provides an option when additional volume is desired in the lateral portion of the breast after a primary reconstruction. The versatility of the intercostal artery perforator. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Based on our success with the deep inferior epigastric perforator artery 2 flap, harvesting only fat and skin from the abdomen, we became interested in applying perforator techniques to the. Perforating artery definition of perforating artery by. Radial artery perforator fascial flap incision academy. Original article the distallybased island ulnar artery perforator.
It essentially involves the transfer of the patients own skin and subcutaneous tissues from the lower abdominal wall to the chest to form the breast mound. Anatomy posterior intercostal bundle the anatomy and course of the intercostal vessels have been thoroughly studied in the anatomical. Thoracodorsal artery perforator flap in breast reconstruction. The deep inferior epigastric artery perforator diep flap. This video demonstrates the propellar flap based on the perforators of posterior tibial artery for medial malleolar defect. Propellar flap based on posterior tibial artery perforators. The flap vascularization is supplied by the skin perforator of the lateral superior genicular artery lsga, the right branch of the popliteal artery 11,14.
The icap flap is also a logical choice for wound closure, if required. However, two major disadvantages of the donor site restrict the flaps clinical applications. Reverse radial artery flap perforator anatomy and clinical. The profunda femoris artery supplies the tissue of the posterior thigh through musculo and septocutaneous perforators. The area of vascularity shown by the spread of contrast extends inferiorly beyond the usual lower border of the profunda artery perforator flap, which is usually 7 cm wide. Request pdf ulnar artery perforator flap the ulnar artery perforator forearm flap uapff shares many of its properties with the radial artery forearm flap by providing versatile, thin.
University of groningen the significance of preoperative vascular. Use of the pedicled medial sural artery perforator msap fasciocutaneous flap has been widely reported in the literature for ipsilateral lower limb reconstruction. Radial artery perforator adipofascial flap interposition topprevent recurrence after resection of posttraumatic radioulnar synostosis. Legitimate use as a solution for the ipsilateral distal lower extremity defect geoffrey g. The ulnar artery perforator forearm flap uapff shares many of its properties with the radial artery forearm flap by providing versatile, thin, pliable, and sensate skin used for soft tissues. Posterior tibial artery perforator flap springerlink. Background the radial artery perforator rap flap has been widely used for covering hand and forearm defects, and realtime accurate perforator mapping is important in planning and elevating the. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. 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. For raising a flap based on the peroneal artery perforator, the patient is also supine with a. This is a pdf file of an unedited manuscript that has been accepted for. Regarding the territory of the digital artery perforator flap, two vascular systems can be selected as the candidate pedicle for this flap. This artery is found within a triangle limited anteriorly by the vastus lateralis muscle, posteriorly by the short head of the biceps femoris muscle.
Deep inferior epigastric perforator flap diep reconstruction is a type of breast reconstruction surgery. Fasciocutaneous propeller flap based on perforating branch of. The facial artery perforator flap for reconstruction of perioral defects. Later on, several other reports concerning the use of this flap have been published2,512. Rather than sacrificing the whole vascular axis in the process of transferring a flap, it was soon.
Freestyle local perforator flaps for facial reconstruction. It essentially involves the transfer of the patients own skin and subcutaneous tissues from the lower abdominal wall to the chest to form. Medial sural artery perforator free flap msap british. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. Flaps can be harvested reliably on a single large perforator system. Using this information, koshima and soeda reported the first clinical use of the lower abdominal skin and fatty tissue for breast reconstruction without sacrificing rectus muscle. The authors present an alternative source using posterior thigh soft tissue based on profunda artery perforators, termed the. Vascular anatomy of the ulnar artery perforator flap. We limit the proximal extent of the flap to the midforearm. Pdf tubed adipofascial radial artery perforator flap for.
The anterior tibial at artery begins at the inferior border of the popliteus muscle, branching from the bifurcation of the popliteal artery, passes between the two heads of the tibialis posterior, through the interosseous membrane, and to the deep part of the anterior leg. Surgical anatomy of the medial sural artery perforator flap wong et al. Posterior tibial perforator flapsoperative technique. Many authors believe that the risk of skin necrosis is reduced by skin flaps such as a rhomboid flap, digital artery perforator flap and rotation flap, which allow excision of mucous deposits. Pedicled peroneal artery perforator flap for knee defect.
Lateral intercostal artery perforator licap flap breast. The medial or lateral sural artery perforator flap should be considered if a thin cutaneous flap is desirable, especially true in the obese patient where there may be few other options. Free style perforator flaps for aesthetic facial reconstruction. Thirtyeight consecutive patients who underwent ulnar artery perforator flap surgery were included in the study. Initially, we used the superior gluteal artery perforator sgap flap when the buttock was needed as a donor site. Bipedicleconjoined perforator flaps in breast reconstruction. Because no muscle is used, an igap flap is considered a musclesparing type of flap. All cases were performed with vigorous debridement, after which the peroneal artery perforator flaps were applied. Perforator flaps of the facial artery angiosome sciencedirect. Koshima et al initially described a pedicled gluteal perforator flap in 1993 but it was based on short parasacral perforating vessels. The radial artery perforator flap is a versatile flap that can be used to provide an interposition barrier after resection of posttraumatic radioulnar synostosis.
Perforator local flaps in lower limb reconstruction. Better understanding of vascular anatomy and pattern of skin circulation has become. Mohan, lin zhu, yoo joon sur, mohamed morsy, gregory j. Surgical anatomy of the medial sural artery perforator flap.
Depending on defect location, the msap flap may be utilized as a propeller or vy advancement flap 1. The pap flap for breast reconstruction was originated in 2010 by dr. A modification to the proximal forearm fascial flap allows the flap to be harvested as a neurosensory flap. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated. This perforator finally pierces the deep fascia to enter the skin of the lower twothirds of the lower leg. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites. Ct angiography of profunda artery perforating arteries. The anatomical basis of the bipaddle rf flap has already been elucidated through several previous investigations on the vascular anatomy of the radial artery and its cutaneous perforator vessels.
Apr 02, 2016 the radial artery perforator rap flap with preservation of the radial artery was firstly reported by zhang for hand reconstruction. An igap flap uses the inferior gluteal artery perforator blood vessel, as well as a section of skin and fat from your lower buttocks basically the lower section of the butt cheek, near the buttocks crease to reconstruct the 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 diep flap requires. This results in a 10 to 15cm long flap, depending on the exact location of the perforator. Background the profunda feomris artery perforator pap flap was recently revisited and gains popularity as an alternative method of. The deep inferior epigastric artery and venae via perforators through the rectus muscle. Medial sural artery perforator msap free flap surgery this leaflet has been written to help your understanding of medial sural artery perforator free flap surgery. The anterior tibial artery perforator atap flap is vascularized by perforators of the anterior tibial artery and has been reported by several authors 1. Indeed, the profunda artery perforator pap flap, which uses the skin and fat of the posterior thigh, has surpassed the gluteal artery perforator gap flap in our practice as the second line donor site for microsurgical breast reconstruction.
734 827 1372 1192 1602 1581 1017 652 1378 851 370 495 502 1449 518 186 1362 1447 627 80 571 370 1583 1267 1314 1563 502 633 708 1595 385 419 1158 567 276 322 240 1149 314 55 376 934 917 1013 453