Clinical Applications, The Perforating Branches Of The Island Flap

BACKGROUND: Perforator flaps have evolved as animprovement over the popular musculocutaneous flaps andfasciocutaneous flaps developed in the 1980s. By selectively harvestingthe skin above the underlying muscle, a reduction in donor site morbidityhas been demonstrated. During the last decade, perforator flaps havebecome increasingly popular in reconstructive surgery in Englishliterature, which is mainly transplanted with microsurgical technique.However, free perforator flap procedures have not seen its wideacceptance in domestic medical centers in recent years, with thefollowing possible causes: time consuming, technique demanding,anastomosis-related risks, and so on. It is well known that pedicled flap ismore safe and convenient than its free counterpart when transferred inshort distance. Pedicled perforator flaps may share these merits, butfurther investigations are also needed.OBJECTIVE: To investigate the feasibility and reliability of thepedicled perforator flaps.METHODS: From May 2003 to January 2006, 17 cases receivedpedicled perforator flap procedures. The clinical data were analyzed.There were 10 males and 7 females, aging from 20 to 85 years with anaverage of 51.1 years. According to the recipient site condition,anterolateral thigh (ALT) flap or deep epigastric inferior perforator (DIEP) flaps was chosen in each patient. The DIEP flaps were all raised onmuscularcutaneous perforators. While the ALT flaps presented with moreanatomic varieties, with the perforators being muscularcutaneous type orseptal type. The DIEP flaps were transferred to the groin area orpeno-scrotal area, while the ALT flaps were brought to the buttock area,groin area, perineum area, and peri-knee area.RESULTS: All pedicled perforator flaps can be raised as planned.Two ALT flap necessitate extra supercharge, one for the too smallerperforator while the other for the too distally located perforator. There arethree case of complications: one donor site infection, one marginalnecrosis of DIEP flap, one totally lose of ALT flap.CONCLUSIONS: Pedicled perforator flap is a reliable cutaneousflap which is very useful in a wide variety of clinical applications. It canachieve better results in reconstructing defect and minimizing donor-sitemorbidity. Because the local anatomic varieties may influence thefeasibility of this kind of flap, it is suggested that the flap procedureshould be performed by a senior surgeon with experiences in flap surgeryand microsurgery.