A machine that can bore a tunnel underground a perforating artery or vein. However, the tram flap, by definition, destroys important abdominal muscles. Inguinal flaps were conventional flaps harvested in textbook style, and. Perforator definition of perforator by medical dictionary. Clearly presented and easy to follow, this excellent australian publication features an accompanying dvd, further exploring this surgical method. His areas of special interest are flap surgery, lymphatic surgery, facial reanimation and facial transplantation. The upper portion is either thickened or shaped into a figure and sometimes has an opening for hanging. The keystone perforator island flap concept, 1e 1st. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring defects throughout the body. Part 1 outlines the fundamental concepts in perforator flap surgery. The keystone perforator island flap concept is the definitive guide to the development, design and surgical application of the effective surgical technique known as the keystone island flap.
Atlas of perforator flap and wound healing springerlink. Allen 1994 borrowed koshimas original work 16 and became the champion of the diep flap for breast reconstruction 19. General surgeons will learn from the descriptions of the vascular basis for skin flaps and from the refined approach to how skin flaps should be designed and elevated. This is distinct from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. The diep flap breast reconstruction operation has many benefits over the tram. Most importantly, the donorsite morbidity is minimal. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. Surgical anatomy of the medial sural artery perforator flap wong et al. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected.
Perforator flap definition of perforator flap by medical dictionary. 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. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. Overview, classification, and nomenclature geoffrey g. Fuchan wei and samir mardini, explains how to achieve excellent results while performing all major conventional and perforator flaps used as both pedicled and free flap procedures. Surgical atlas of perforator flaps download ebook pdf. A clear definition of propeller flap was given in 2009 by the advisory panel of the first tokyo meeting on perforator and propeller flaps, who defined it as an island flap that reaches the recipient site through an axial rotation. Anatomy of the abdominal skin harvested with the diep flap. The deep inferior epigastric artery perforator diep flap. Whether youve loved the book or not, if you give your honest and detailed thoughts then people will find new books that are right for them. With the report of freestyle free flaps by wei and mardini 20, a new gate has been opened for reconstruction of defects using tissues harvested from anywhere of the body provided that tissue encountered is the most suitable and similar and is supplied.
The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. Volume ifundamentalshistory of perforator flap surgery. A brief history of perforator flaps hallock journal of. Ashton definition and nomenclature of propeller flaps. On the right side of the abdomen, a large diep perforator through the rectus muscle is illustrated. What started as a small meeting among friends, has grown into a major international forum where colleagues share their new ideas in the field of perforator.
Atlas of perforator flap and wound healing bookshare. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular septa. This is done to fill a defect such as a wound resulting from injury or surgery when the. Surgical anatomy of the medial sural artery perforator flap. The principle that additional effort and time need to be spent to dissect the perforator out from between the muscle fibers to reduce the donor morbidity was the. 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. However, the anatomic variations decreased its popularity.
The perforator for the pap flap travels through the adductor magnus muscle. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. Perforator flaps for breast reconstruction download. Perforator flaps has two volumes, a total of 1096 pages, and 972 references. Hyakusoku 1991 coined the term propeller flap, although it wasnt until later that the hub providing flap circulation was found to be more versatile if relying on a perforator vessel. Perforator a prehistoric tool in the form of a pointed stick made of wood or bone. The purists among us stated that a muscle perforator flap is the only real perforator flap. Although the definition of perforators and perforator flaps is still somewhat controversial, it is generally. For example, thin perforator flaps from the inguinal region can be used. Other readers will always be interested in your opinion of the books youve read. The concept of the perforator flap was introduced by kroll et al.
Atlas of perforator flap and wound healing microsurgical. A flap vascularized by a septal perforator is called a septal perforator flap. Perforator medical definition merriamwebster medical. Perforator flaps have provided freedom of flap design with over 350. A newer version of the flaptummy tuck method is called diep reconstruction deep inferior epigastric perforator reconstruction, which uses the same fatty tissue from the tummy but leaves your abdominal muscles intact. Two lanceolate basalt points and a slate perforator tom dillehay largerimage monte verde under fire. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb, and the trunk. Plastic surgery perforator flaps thieme medical publishers.
The propeller flap is an islanded fasciocutaneous flap based on a. The first chapters set the stage in regard to the fundamentals, which include excellent discussions of the history of flap surgery, vascular. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery. Perforator flap surgery is a technique used in reconstructive surgery where skin andor. Perforator article about perforator by the free dictionary. The term perforator flap, used to define a new type of flap, has recently been introduced in the medical field and in the clinical practice of plastic surgeons.
Subsequent descriptions have since detailed its widespread applications, with the largest series to date published by wei and colleagues in 2002, in which they reported their. He is a professor of surgery at uw and director of the center for reconstructive surgery at uwmc. Hauer described the subfascial endoscopic perforator vein surgery seps technique allowing ipvs to be clipped through a small incision. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. Although the definition of perforators and perforator flaps is still somewhat controversial, it is generally accepted that a flap based on either a septocutaneous or musculocutaneous perforator can be called a perforator flap, whether the skin or only the subcutaneous fat or fascia is included. Perforator definition of perforator by the free dictionary. Perforator flaps can be used as local perforator flaps or as perforator free flaps.
Atlas of perforator flap and wound healing uk education. Our results of this novel technique are encouraging for future studies and trials in axial and perforator flap models. Anterolateral thigh flap an overview sciencedirect topics. The reader will find that these extraordinary statements are well supported by the case examples in the book. On the basis of this definition we set out to revise all the current literature in order to individualize the first true perforator flap, and to catalog all the perforator flaps described up to now in the literature.
The clinical application of anterolateral thigh flap. Nonmuscle perforator flaps, in particular neurocutaneous perforator flaps, are also discussed in this section. The pap and accompanying veins arise from deep within the thigh and run posteromedially, providing blood flow to the upper medial and posterior thigh. The difference between a propeller flap and other pedicled flaps is. The disadvantages of tram flap breast reconstruction. Deqing hu this atlas is organized in a way with a combination of basic theory and clinical practices, and of real photos and text description in perforator flap. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Perforators definition of perforators by the free dictionary. Lastly, some brief information and examples of perforatorbased workhorse flaps are given.
Figure 6 a a 22yearold male presented with a left foot degloving injury with. Atlas of perforator flap and wound healing pdf libribook. By adapting freestyle flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator. On the contralateral side, the superficial inferior epigastric artery siea and the superficial inferior epigastric vein siev are demonstrated. The muscle is large, and runs parallel, posteror and deep to the gracilis muscle. Both operations use the patients own body tissue to make a new breast after mastectomy. Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. Seps was superseded in 2001 by a minimally invasive technique using pin hole surgery, called transluminal occlusion of perforators trlop 10 which by 2009 had shown to be as effective as seps. Perforator flap definition of perforator flap by medical. A perforator flap is a flap consisting of skin and subcutaneous tissue that is perfused by an isolated artery. 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. Pdf the term perforator flap, used to define a new type of flap, has.