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.

Schlüsselwörter

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

Key words

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

References

• 1 Acland R D, Schusterman M, Godina M. The saphenous neurovascular free flap.  Plast Reconstr Surg. 1981;  67 763-774
• 2 Amarante J, Costa H, Soares R. A new distally based fasciocutaneous flap of the leg.  Brit J Plast Surg. 1986;  39 338-340
• 3 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle.  Plast Reconstr Surg. 1995;  96 1608-1614
• 4 Barclay T C, Cardosa E, Sharpe D T, Crocket D J. Repair of lower leg injuries with fasciocutaneous flaps.  Brit J Plast Surg. 1982;  35 127
• 5 Cormack G C, Lamberty B GH. A classification of fascio-cutaneous flaps according to their patterns of vascularization.  Brit J Plast Surg. 1984;  37 80-87
• 6 Hong G, Steffens K, Wang F B. Reconstruction of the lower leg and foot with the reverse pedicled posterior tibial fasciocutaneous flap.  Brit J Plast Surg. 1989;  42 512-516
• 7 Hung L K, Chen S Z, Leung P C. Resurfacing difficult wounds: selective use of the posterior tibial flap.  J Reconstr Microsurg. 1990;  6 13-19
• 8 Kim J T, Koo B S, Kim S K. The thin latissimus dorsi perforator-based free flap for resurfacing.  Plast Reconstr Surg. 2001;  107 374-382
• 9 Kimura N, Satoh K, Hasumi T, Ostuha T. Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients.  Plast Reconstr Surg. 2001;  108 1197-1208
• 10 Koshima I, Endo T, Soeda S, Yamasaki M. The free or pedicled saphenous flap.  Ann Plast Surg. 1988;  21 369-374
• 11 Koshima I, Soeda S. Inferior-epigastric skin flaps without rectus-abdominis muscle.  Brit J Plast Surg. 1989;  42 645-648
• 12 Koshima I, Soeda S. Free posterior tibial perforator-based flaps.  Ann Plast Surg. 1991;  26 284-288
• 13 Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A. The vasculature and clinical application of the posterior tibial perforator-based flap.  Plast Reconstr Surg. 1992;  90 643-649
• 14 Koshima I, Saisho H, Kawada S, Hamanaka T, Umeda N, Moriguchi T. Flow-through thin latissimus dorsi perforator flap for repair of soft-tissue defects in the legs.  Plast Reconstr Surg. 1999;  103 1483-1490
• 15 Koshima I, Kawada S, Etoh Kawamura H S, Moriguchi T, Sonoh H. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities.  Plast Reconstr Surg. 1995;  95 252-260
• 16 Koshima I, Urushibara K, Inagawa K, Moriguchi T. Free tensor fasciae latae perforator flap for the reconstruction of defects in the extremities.  Plast Reconstr Surg. 2001;  107 1759-1765
• 17 Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N. Free thin paraumbilical perforator-based flaps.  Ann Plast Surg. 1992;  29 12-17
• 18 Koshima I, Yamamoto H, Hosoda H, Moriguchi T, Orita Y, Nagayama H. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: An introduction to the chimeric flap principle.  Plast Reconstr Surg. 1993;  92 411-420
• 19 Koshima I. A new classification of free combined or connected tissue transfers: Introduction to the concept of bridge, Siamese, chimeric, mosaic, and chain-circle flaps.  Acta Med Okayama. 2001;  55 329-332
• 20 Liu K, Li Z, Lin Y, Cao Y. The reverse-flow posterior tibial artery island flap: Anatomic study and 72 clinical cases.  Plast Reconstr Surg. 1990;  86 312
• 21 Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg.  Brit J Plast Surg. 1981;  34 215-220
• 22 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery.  Brit J Plast Surg. 1984;  37 149-159