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Advanced autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
Autologous reconstruction of a breast is recreating a well-organized living structure in the three dimensions of space. This new structure should try to mimic the shape, volume, and texture of a normal breast. Autologous tissue transfer has become the gold standard in breast reconstruction and in creating this defined structure. Autologous reconstruction is preferred over implant reconstruction in an attempt to avoid the long-term complications of implant-based reconstruction. The use of perforator flaps provides additional advantages from reduction of donor site morbidity while providing the best volume and skin restoration. Reliability and versatility of this technique is well-established.1 Regardless of the flap used for breast reconstruction, secondary procedures to the flap and to the contralateral breast are almost always needed to ultimately achieve satisfactory and symmetrical results.
General plastic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
A perforator flap is a flap of skin/fat supplied by a perforating branch of the source vessel, passing through deep tissues and fascia to supply the flap. Some have coined the phrase ‘perforasome’ to describe the block of tissue supplied by one perforator vessel.
Reconstructive Microsurgery in Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
John C. Watkinson, Ralph W. Gilbert
Most recently a great deal of interest and terminology has evolved around the concept of perforator flaps (Figure 93.1).3 A perforator flap consists of skin and/or subcutaneous tissues supplied by a perforating vessel that passes through or between the deep tissues, usually muscle. A muscle perforator is a vessel that traverses through muscle to supply the overlying skin. A septal perforator is a vessel passing only through an intermuscular septum to supply the overlying skin. A flap vascularized by a muscle perforator is called a muscle perforator flap and a flap vascularized by a septal perforating vessel is called a septal perforator flap. Based on this nomenclature, flaps may be described based on the anatomy of their supplying vessels. For example, the perforator based skin flap arising on the deep inferior epigastric artery that traverses the rectus abdominus muscle is called the deep inferior epigastric perforator flap and is a muscle perforator flap.
A trial to visualize perforators images from CTA with a tablet device: experience of operating on minipigs
Published in Computer Assisted Surgery, 2022
Hisato Konoeda, Miyuki Uematsu, Nie Jumxiao, Ken Masamune, Hiroyuki Sakurai
In the past two decades, perforator flaps have been commonly used in reconstructive surgeries to reduce postoperative complications. When raising perforator flaps, it is necessary to dissect the vascular structure meticulously, mainly because of their irregular anatomical vascular distribution [1,2]. To avoid damaging the vasculature of perforator flaps, it is important for surgeons to confirm where suitable perforators are located and to understand the underlying vessel structure by performing preoperative medical imaging. Several imaging methods have recently been utilized for preoperative surgical assessment and planning. Hand-held Doppler ultrasound, color Doppler ultrasound, computed tomography angiography (CTA), and magnetic resonance angiography (MRA) [3–6] are widely used to determine vascular variations in patients.
Treating a rare mid-term complication of transapical transcatheter aortic valve implantation (TAVI): a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Eugenio Fraccalanza, Alessandra Fin, Nicola Zingaretti, Filippo Contessi Negrini, Enzo Mazzaro, Ugolino Livi, Pier Camillo Parodi
The Plastic Surgery proposed via perforator flap repair. A portable Doppler probe was used to identify an intercostal artery perforator in the 6th intercostal space [1]; a tear-shape flap was centred on this vessel, with the upper margin of the flap coinciding with the lower margin of the defect (Figure 1). After debridement, the flap was raised and the pedicle directly examinated. We found that the flap could be sufficiently mobilised without using the island technique, thereby sparing the inferior and medial extensions of the surgical incision. The portion of tissue distal to the perforator was de-epithelialized and used to fill the defect; fibrin sealant Tisseel (Baxter Healthcare Corp., Deerfield, IL) was applied to promote flap adhesion to the surrounding tissue and further reduce dead space (Figure 2(A–C)). The wound was closed by bringing the upper margin of the flap to the upper margin of the defect (Figure 3). Surgery time for wound cleaning and reconstruction was 100 min. At the last clinical and CT control (June 2019) the flap was completely consolidated with the thoracic tissues, scars were well healed and no distortion of the thoracic surface was noted (Figure 4(A,B)).
Impact of Diameter of Perforator in Pedicle and Different Managements of Intermediate Non-Pedicle Perforator on Flap Survival in Rats
Published in Journal of Investigative Surgery, 2022
Donghong Liu, Fang Fang, Yuehong Zhuang
Flaps are the main tool adopted for reconstruction or resurfacing of large soft-tissue defects that often result from tumor removal, burns, and trauma [1–3]. Among the many flap types, the perforator flap, owing to its minimal donor site injury and versatile applications, is popular with reconstructive surgeons. It is now generally accepted that if a flap is confined to the perforasome of the perforator in the pedicle, it is almost immune to ischemia and necrosis. However, if a flap extends beyond the perforasome of the pedicle, the likelihood of necrosis gradually increases, resulting in partial necrosis in the second choke zone, as suggested by Taylor [4]. Because the blood supply from the vascular pedicle gradually decreases as the distance from the pedicle increases, the length of the flap is a critical factor in determining the necrosis rate. Therefore, it is of crucial clinical importance for surgeons to estimate the length of a flap that can be harvested based on the diameter of the perforator.