Extended knowledge of vascular anatomy has propagated the development of perforator flaps, which preserve muscle function and reduce morbidity. This has been achieved through the exemplary works of Manchot, Salmon, Milton, Taylor, and many others. With over 350 clinically relevant perforators in the body, this has created new flap options and a sense of creative freedom for reconstruction tailored toward a specific defect, without constraints of specific landmarks and using a “free-style” approach. Dominant perforators may be found in zones of high perforator density or “hot spots,” which can help to conceptualize local flap options and aid flap design. This article aims to outline the history, physiology, and principles of flap design and harvest, and highlight traditional and evolving concepts and modifications ofcontemporary and traditional flaps that are changing reconstructive practice. This is a broad overview focusing on clinical applications, highlighting key concepts in a selection of new or evolving flaps being used in clinical practice and providing source references to acquire detailed flap descriptions.
After viewing this course, the participant should be able to:
Understand the history and physiology of perforator flaps.Understand the concept of “free-style” perforator flaps and principles in design and harvestUnderstand the uses of perforator flaps in reconstruction and applications in new settings.Understand new principles in single and multiple perforator flap harvest and adjunct techniques that can be used in perforator flaps.Highlight pertinent anatomy and techniques for selected perforator flaps described.
Anita T. Mohan, MRCS MBBS; Yoo Joon Sur, MD PhD; Lin Zhu, MD; Mohamed Morsy, MBBCh MSc; Peter S Wu, MD MS; Steven L. Moran, MD; Samir Mardini, MD; Michel Saint-Cyr, MD
Plastic and Reconstruction Surgery® Editors:
Editor-in-Chief: Rod J. Rohrich, MD
Co-Editor: James M. Stuzin, MD
Section Editor: Donald H. Lalonde, MD
Patient Safety Credit:
Journal Article, Video Publish Date:
6/1/2016Estimated time to complete this course:
Directly provided by the American Society of Plastic Surgeons® (ASPS®)
The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.
Dr. Rohrich, MD is the Principal/Co-Principal Investigator of research grants awarded to the University of Texas Southwestern Medical Center, Dallas, from Medicis, Mentor, and Contura Pharmaceutical. All research funds are provided directly to UT Southwestern. Dr. Stuzin has no relevant financial relationships or affiliations to disclose. Dr. Lalonde is a consultant for ASSI Instruments. None of the authors have any relevant financial relationships or affiliations to disclose.
All ASPS staff members
managing this activity have no relevant financial relationships or affiliations to disclose. All identified conflicts of interest have been resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity, and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.
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