Algorithms for perforator-based flaps in different anatomical locations

Abstract

Introduction: Perforator-based flaps can be planned in any anatomic location in the body when there is a detectable perforator. Although preoperative perforator mapping ensures safety and versatility of these flaps, there is no consensus yet about flap planning in different anatomical locations. Material and Method: 28 patients underwent perforator-based flap surgery for different anatomical locations as face (5), sternum (3), back (5), lomber (4), sacral (4) and scrotal (4) areas, leg (2) and foot (1). 19 of the patients were male while 9 were female. The mean age was 58.1±13.5 (22-80 years). Perforator-based flaps were planned as V-Y design in face, sacral and scrotal areas while as perforator plus transposition flaps for lomber area, leg and sternum. On the other hand, for foot the flap was planned as subcutaneous-pedicled turnover flap. Results: The mean follow-up time was 10 months (3-36 months). Partial flap necrosis is seen in all 3 patients who had underwent flap surgery on the lower extremity. There were no other complications seen in short- or long-term follow-ups. Comorbid diseases were not statistically significant on complications rates (P>0.05). Conclusion: V-Y flap for the face and the sacral area; and perforator plus transposition flap for back ,lomber area and sternum are suggested as the ideal flap modifications for these anatomical locations. On the other hand, perforator-based flaps should not be used as a first choice in reconstruction of lower extremity defects.

Keywords

• Perforator-based
• Versatility
• Flap modification
• planning

Thanks

we thank Salih Ergoçen for his assistance in statistics

References

1. JT, Kim SW. Perforator flap versus conventional flap. J Korean Med sci.2015; 30: 514-22.
2. Kim JT, Ho SYM, Hwang JH, Lee JH. Perineal perforator–based island flaps: The next frontier in perineal reconstruction. Plast Reconstr Surg 2014; 133: 683-7.
3. Yıldırım S, Taylan G, Aköz T. Freestyle perforator-based VY advancement flap for reconstruction of soft tissue defects at various anatomic regions. Ann Plast Surg 2007; 58: 501-6.
4. Song P, Pu LL. Perforator-plus flaps in lower extremity reconstruction. Clin Plast Surg 2021; 48: 183-92.
5. Kennedy A-M, Lloyd MS, Niranjan NS. Versatility of pedicled perforator-based vy advancement flaps for reconstruction of the upper limb: a case series and review of the literature. Ann Plast Surg 2020; 84: 529-34.
6. Retrouvey H, Mahoney M-H, Pinchuk B, Jalil W, Somogyi R. The versatility of lateral chest wall perforator flaps in immediate and delayed breast reconstruction: retrospective study of clinical experience with 26 patients. Plastic Surgery 2021: 22925503211051110.
7. Kim SW, Kim YH, Kim JT. Angular artery perforator‐based transposition flap for the reconstruction of midface defect. Int J Dermatol 2012; 51: 1366-70.
8. Can B, Koçman AE. Perforator-based V–Y advancement medial thigh flap for scrotal and perineal reconstruction after fournier gangrene. Indian J Surg 2022: 84; 170-6

9. Wei ZR, Chang SS. Brief introduction of perforator flap. Zhonghua Shao Shang Za Zhi 2019; 35: 481-5.
10. Hashimoto I, Abe Y, Ishida S, et al. Development of skin flaps for reconstructive surgery: random pattern flap to perforator flap. J Med Invest 2016; 63: 159-62.
11. Kalus R, Zamora S. Aesthetic considerations in facial reconstructive surgery: the VY flap revisited. Aesthetic Plast Surg. 1996; 20: 83-6.
12. Mehrotra S. Perforator-plus flaps: a new concept in traditional flap design. Plast Reconstr Surg 2007; 119: 590-8.
13. Wong C-H, Tan B-K. Perforator-plus flaps or perforator-sparing flaps: Different names, same concept. Plast Reconstr Surg 2007; 120: 1746-7.
14. Kannan RY. The internal mammary artery perforator flap and its subtypes in the reconstruction of median sternotomy wounds. J Thorac Cardiovasc Surg 2016; 152: 264-8.
15. Eburdery H, Grolleau J, Berthier C, Bertheuil N, Chaput B. Management of large sternal wound infections with the superior epigastric artery perforator flap Ann Thorac Surg 2016; 101: 375-7.
16. Morris SF, Tang M, Almutari K, Geddes C, Yang D. The anatomic basis of perforator flaps. Clin Plast Surg 2010; 37: 553-70.
17. Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator-based propeller flaps for lower-extremity reconstruction Clin Orthop Relat Res 2014; 472: 2276-86.
18. Saito A, Sawaizumi M, Matsumoto S, Takizawa K. Stepladder V–Y advancement medial thigh flap for the reconstruction of vulvoperineal region J Plast Reconstr Aesthet Surg 2009; 62: 196-9.
19. Yang C-H, Kuo Y-R, Jeng S-F, Lin P-Y. An ideal method for pressure sore reconstruction: a freestyle perforator-based flap. Ann Plast Surg 2011; 66: 179-84.
20. Lin C-H, Ma H. Perforator-based fasciocutaneous flap for pressure sore reconstruction. J Plast Surg Hand Surg 2012; 46: 430-3.
21. Bonomi S, Salval A, Brenta F, Rapisarda V, Settembrini F. The Pacman perforator-based VY advancement flap for reconstruction of pressure sores at different locations. Ann Plast Surg 2016; 77: 324-31.
22. Chih-Hsun L, Ma H. Use of perforator-based fasciocutaneous flaps for pressure sore reconstruction: Single-perforator-based versus multiple-perforator-based flaps. Aesthetic Plast Surg. 2016; 40: 540-8.