Perforator Flaps in Lower Extremity Reconstruction

Zusammenfassung

Perforans-Lappenplastiken werden als Hautlappenplastiken ohne Faszie oder Muskel definiert. Sie werden von einem oder mehreren Perforans-Gefäßen versorgt, die die Hautinsel entweder durch die Faszie, den Muskel oder das Septum intermusculare erreichen. Bereits 1985 wurde in Japan das Konzept der Blutversorgung von Lappenplastiken über Perforans-Gefäße gegenüber dem Konzept der faszio-kutanen Blutversorgung, also die Versorgung der Haut über den Gefäßplexus der Faszie, vertreten. Gestielte Perforans-Lappenplastiken unterteilen wir in septo-kutane, muskuläre (intermuskuläre), periostale und intertendinöse Perforans-Lappenplastiken. An der unteren Extremität wurden die A. tibialis posterior-Perforans-Lappenplastik, die Saphenus-Insel-Lappenplastik, die Peroneus Insel-Lappenplastik, die Malleoläre-Perforans-Lappenplastik, die freie A. epigastrica inferior-Perforans-Lappenplastik (DIEP Flap), die antero-laterale Oberschenkel-Perforans-Lappenplastik (ALT Flap) und die freie A. thoracodorsalis-Perforans-Lappenplastik (T-DAP oder TAP Flap) beschrieben. Der Vorteil dieser Perforans-Lappenplastiken sind der minimale Hebedefekt, die schnelle Lappenhebung und eine zuverlässig durchblutete Hautinsel.

Abstract

Perforator flaps are defined as skin flap without fascia or muscle and they are nourished by one or more perforating vessels perforating the fascia, muscle, or intermuscular septum. As early as 1985 in Japan, we proposed this concept over that of the fasciocutaneous flap, which was believed to be nourished by fascial plexus. The pedicle perforators are classified as septocutaneous, musclular (intermuscular), periosteal, and intertendinous perforators. As useful perforator flaps in the lower extremity, posterior tibial perforator island flaps, saphenous island flaps, peroneal island flaps, malleolar island perforator flaps, deep inferior epigastric perforator free flap (DIEP flap), anterolateral thigh free flap (ALT flap), and latissimus dorsi muscle free perforator flap (thoracodorsal artery perforator flap, T-DAP or TAP flap) were described. These flaps have the advantage of minimal donor-site morbidity, relatively rapid dissection and flap elevation, and reliable skin territory.

A. tibialis posterior-Perforans-Lappenplastik - Saphenus-Insel-Lappenplastik - A. epigastrica inferior-Perforans-Lappenplastik (DIEP Flap) - A. thoracodorsalis-Perforans-Lappenplastik (TAP Flap)

Posterior tibial perforator flap - saphenous island flap - deep inferior epigastric perforator flap (DIEP flap) - thoracodorsal artery perforator flap (TDAP flap)

References

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