The history of evolution something new is something old that has been forgotten. The supraclavicular flap has been used for the coverage of defects over the sternum, neck, trachea, retroauricular area, cheek, and oral cavity. An anatomical basis for the flap using a pedicle containing a cervical, nonperforating cutaneous branch of. The versatility of perforatorbased propeller flap for.
Introduction the supraclavicular flap was reported first by lamberty in 1979. Microsurgery imap flap head and neck reconstruction. In larger case series the major complication rate is flaps in 79 patients. Perforator flaps have gained popularity in recent years in many aspects of reconstruction and the initial chapter of the book provides a brief history of flap surgery.
The thoracoacromial artery perforator taap flap used in its pedicle or in the free microvascular variant is an emerging flap for use as a reconstructive option for the head and neck. 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. Medial sural artery perforator free flap msap british. Preexpanded perforator flaps, an issue of clinics in plastic. A hand held doppler was used to localize the supraclavicular vessel as it crossed the clavicle and its further course and direction was mapped figure 1a. Supraclavicular artery island flap plastic surgery key. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring. To unify the widely varying nomenclature and in the light of the new classifications regarding perforator flaps, we propose to rename the flap as the supraclavicular artery perforator sap flap. The clinical application of anterolateral thigh flap.
The anterior supramalleolar perforator flap is pedicled on the superior malleolar cutaneous branch of the anterior tibial artery. The flap is elevated from lateral and superior toward the medial aspect, deep to the muscular fascia and above the gluteus maximus muscle. Surgical anatomy of the medial sural artery perforator flap. Today, partial breast resections represent the mainstay surgical management for early stage breast cancer. Supraclavicular artery perforator flap in management of. Supraclavicular artery island flap for reconstructing defects in the head and neck region. We propose to name the flap as the anterior supraclavicular artery perforator asap flap to distinguish it from other flaps harvested in this area. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. A study of the use of the supraclavicular artery flap for. Recently, the authors have modified the sap flap by using an anterior branch of. Section b local and free flaps in the chest, 387 33 supraclavicular artery flap, 387 michael r.
The anterolateral thigh flap can provide a large skin paddle nourished by a long and largecaliber pedicle and can be harvested by twoteam work. Posterior tibial arterybased perforator flaps were used in five cases and peroneal arterybased perforator flaps in three cases. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. The supraclavicular flap can be harvested as a pedicled fasciocutaneous flap or as a free flap. Lateral thigh perforator ltp flap for autologous breast.
As a result, widespread use of perforator flaps, either pedicled or free, has become possible. Pu and chunmei wang, is devoted to preexpanded perforator flaps. An assessment of the anatomical basis of the thoracoacromial. Plastic surgery perforator flaps thieme medical publishers. Perforator flap definition of perforator flap by medical. The perforator flaps for breast reconstruction have been used at louisiana state university medical center since 1992. Jan 12, 2015 the skin area that can be harvested with this flap ranges from 1016 cm wide to 2230 cm long. Jan 30, 2017 the use of free flaps greatly improves reconstruction options and quality of life for patients undergoing oncological resections. The flap dimensions needed are outline, with the perforator on the longitudinal axis of the flap. Profunda artery perforator pap flap for breast reconstruction. 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. Moreover, a new subtype based on the anterior supraclavicular artery perforator flap has been harvested with satisfactory results.
Excellent book, excellent service by amazon, as always. The first patient was a 52yearold woman who had undergone previous attempts at breast reconstruction with a failed transverse rectus abdominis muscle tram flap and a failed implant. A perforator flap is a flap of skin or subcutaneous tissue that is based on the dissection of a perforating vessel, which is a perforator. 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. Evolution of flaps has continued after the introduction of fasciocutaneous and musculocutaneous flaps. In short, a perforator is a vessel that has its origin in. Allen at the th international course on perforator flaps in mexico city. The perforator can be at the center, distal or proximal aspect of the flap, depending on the needed orientation in the recipient area. By adapting freestyle flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. However, the anatomic variations decreased its popularity. Request pdf the supraclavicular artery perforator flap. 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. Supraclavicular artery island flap iowa head and neck protocols.
Perforator flaps are an important step in the evolution of reconstructive surgery. Thoracodorsal artery perforator flap for reconstruction. In this study, we have tried to evaluate the role of thoracodorsal artery perforator flap tdap in oncoplastic breast surgery. Better understanding of vascular anatomy and pattern of skin circulation has become possible by numerous cadaveric studies. Apr 02, 2016 pedicled perforator flaps are also called local perforator flaps, or island perforator flaps. Preexpanded perforator flaps, an issue of clinics in plastic surgery volume 441 the clinics. Medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap. Because this flap has not been extensively described for head and neck reconstruction of oncologic defects, guidelines for its indications would benefit the reconstructive surgeon. Previous concerns of distal tip ischemia have been addressed with modifications in operative technique, cadaveric perfusion studies 4, and radiographic imaging 5. A comparative study of imaging techniques used in preoperative mapping background the supraclavicular artery flap is an excellent flap. It is a fasciocutaneous flap located in the middledistal third of the lower leg. Perforator flaps have evolved, and they have provided many new flaps with new pedicles all over the body presenting important advantages.
The pap flap for breast reconstruction was originated in 2010 by dr. The most common flaps used are those taken from the abdomen or buttocks based on the deep inferior epigastric perforators or the gluteal artery perforators, respectively. Perforator flaps for breast reconstruction download. Microsurgery double free flap with fibula and alt head and neck reconstruction duration. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice.
When the larger perforator s are identified as one proceeds medially, they are traced into the muscle with bipolar dissection and dissected to their exit from between the piriformis and gluteus medius muscles. This results in an ellipse with its anterior longitudinal arc skirting the lateral border of the latissimus. Purchase preexpanded perforator flaps, an issue of clinics in plastic surgery, volume 441 1st edition. The distal end of this flap can extend to the midportion of the deltoid with a slight anterior placement. This microsurgical breast reconstruction technique allows patients to rebuild a naturallooking breast after mastectomy. When local perforator flap is designed as propeller and rotated to 180 degree, donor site is closed primarily and increases reach of flap, thus increasing versatility. This issue of clinics in plastic surgery, guest edited by drs.
Stacked deep inferior epigastric perforator flap breast reconstruction. Perforator flaps have provided freedom of flap design with over 350. Lap flap breast reconstruction lap flap lumbar artery perforator flap is designed to use the soft tissue of the waistline at the lower back and the flanksthe lovehandle areas. Apr 10, 2017 lateral thigh perforator ltp flap for autologous breast reconstruction the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. Perforator variability in the anterolateral thigh free flap. The supraclavicular artery island flap in head and neck. Listing a study does not mean it has been evaluated by the u. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected. Importance the supraclavicular artery island sai rotational flap may have advantages compared with freetissue transfer in head and neck reconstruction.
In one specimen, this perforator was located more distally, 15 cm from the popliteal crease. Angrigiani et al 1 first described harvesting a cutaneous island of the latissimus dorsi flap without the muscle based on one cutaneous perforator. The flap marking was done conforming to the territory over the shoulder cap as described by pallua et al. A second perforator wasfoundinthe medial row at 10 cm distal to the popliteal crease. The anterolateral thigh alt free flap is frequently used in the head and neck. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular.
Preexpanded perforator flaps, an issue of clinics in. Advancing education, research, and quality of care for the head and neck oncology patient. Most importantly, the donorsite morbidity is minimal. Supraclavicular artery island flap iowa head and neck. Anterior supramalleolar perforator flap springerlink. Since that time, the flap has been widely used and reported on. If the neck was unburnt, the sternocleidomastoid, external jugular vein, and clavicle were marked to obtain the exit. A new pedicled or free perforator flap based on the anterior supraclavicular vessels.
Thoracoacromial artery perforator flap request pdf. Perforator flap perforator flap meeting 2017 columbus ohio. It combines the advantages of pedicled local flaps good color and texture match, likewithlike reconstruction, pedicled regional flaps up to 180 arc of rotation, pedicled distant flap vascular reliable and larger size, and without microsurgical vascular anastomosis. The supraclavicular artery island flap pocket dentistry. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. Chiu 34 pectoralis major flap, 396 william ignace wei, chan yu wai expert commentary hungchi chen 35 deltopectoral flap and internal mammary artery perforator flap, e87. Atlas of perforator flap and wound healing microsurgical. In our department, the thoracodorsal artery perforator tdap flap is widely used as free flap for large defects on extremities. The role of thoracodorsal artery perforator flap in. Chimeric stacked deep inferior epigastric perforator flap breast reconstruction. 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. A broad search was undertaken through the pubmed database using the. From june 2008 to may 2011, 20 patients were treated with perforator based propeller flap for distal leg and ankle defects.