• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권3호
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• pp.200-209
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• 2013

Over the past few years, a large number of perforator flaps have been revised by several microsurgeons in the USA, France, Canada and Japan. A perforator flap is a flap of skin or subcutaneous tissue that is based on the dissection of a perforating vessel, which is a perforator. In short, a perforator is a vessel that has its origin in one of the axial vessels of the human body. By reducing any muscle harvesting and trauma to a minimum, perforator flaps aim to minimize donor site morbidity, and by avoiding the transfer of dennervated muscle, the long-term bulk of the free tissue transfer becomes more predictable. There are a finite number of potential perforator flaps in the body, which are based on the named source arteries. The most commonly used perforator flaps are deep inferior epigastric perforator, superior gluteal artery perforator, thoraco dorsal artery perforator, medial sural artery perforator, and anterolateral thigh perforator flap. For a better understanding of perforators as a routine reconstructive procedure in oral and maxillofacial surgery, the definition with nomenclature, classifications with special characteristics, and review points for their individual applications must be learned and memorized by the young doctors in the course regarding the special curriculum periods for the Korean national board of oral and maxillofacial surgery. Perforator flaps have been known to have many advantages, so this review article summarized their applications to the maxillofacial reconstruction in the Korean language.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.50-55
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• 2015

In the hand, few vessels can be classified as 'perforators'. Even today, the debate continues on whether or not branches of the digital artery should be considered as perforators. However, 'perforator' and 'perforator flaps' have become extremely popular within the microsurgery literature, and as such, the terminology has found widespread adoption across the hand surgery field. The finger is the most important sensory organ for tactile stimulation. The glabrous skin can be distinguished between the fingertip and the proximal tissue, with the fingertip having a higher functional and, therefore, reconstructive priority. Thus, sacrifice of the proximal glabrous skin can be justified in the reconstruction of fingertip defects. In this paper, the author reviews two flaps, 'lateral digital artery perforator flap' and 'volar digital artery perforator flap', both of which uses short branches of the digital artery as a vascular pedicle and are useful in fingertip construction.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.92-98
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• 1996

The rectus abdominis myocutaneous flap is frequently used in the field of plastic and reconstructive surgery such as breast reconstruction and as a donor of free tissue transfer. Major problems with this flap is bulkiness, the possibility of postoperative abdominal herniation and muscle weakness following the removal of the rectus abdominis muscle. We used paraumbilical perforator based skin flap fed by a muscle perforator from the deep inferior epigastric artery, with no or little muscle and fatty tissue, in three patients for the resurfacing of relatively wide and thin defects. This technique has all of the advantages of the conventional rectus abdominis myocutaneous flap with decreased possibility of postoperative abdominal herniation or muscle weakness. Another challenging merit is possibility of skin flap thinning.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.348-350
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• 2009

Purpose: The objective of this study is to present a reliable method of scrotal reconstruction. Methods: 75 year - old - man visited the out patient department of urology for chronic itching sensation in his scrotal area, diagnosed as Bowen's disease. After the wide resection of scrotal lesion, reconstruction was carried with pedicled anterolateral thigh perforator flap. All operation procedure was done with an usual manner, previously reported. Donor site was closed primarily. Results: In 6th month follow - up period, there was no event, such as flap necrosis, wound dehiscence, tumor recurrence. And tactile sensation was recovered. Conclusion: In the Korean literature, there have not been the report that describes the reconstruction of scrotal defect using pedicled anterolateral thigh perforator flap. Pedicled anterolateral thigh perforator flap is reliable and robust flap for scrotal reconstruction.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.235-240
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• 2011

Purpose: Management of pressure sores has been improved, along with development of musculocutaneous flaps and perforator flaps. Nowadays, the treatment of pressure sore with perforator flaps has shown several advantages, including minimal donor site morbidity, relatively versatile flap design not only in primary cases but also in recurred cases and minimized anatomical rearrangement of regional muscle position. In this study, we report our clinical experience of gluteal perforator flap used in the treatment of a greater trochanteric pressure sore. Methods: A clinical study was performed on 7 patients who underwent total 10 operations. 1 superior gluteal artery perforator flap and 9 inferior gluteal artery perforator flaps were used to reconstruct the defect, followed by the mean observation duration of 22 months. Results: There were no total flap loss. We treated 2 cases of partial flap loss with debridement and primary repair. 2 recurred cases were successfully treated using the same method. Donor sites were all primarily repaired. Conclusion: The gluteal perforator flap could be considered as a safe and favorable alternative in the treatment of soft tissue defects in the greater trochanteric area. The advantages of the flap include low donor site morbidity and the possibility of versatile flap design not only in primary cases but also in recurred cases.

• Archives of Plastic Surgery
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• 제40권6호
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• pp.754-760
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• 2013

Background Classical flaps for perinasal defect reconstruction, such as forehead or nasolabial flaps, have some disadvantages involving limitations of the arc of rotation and two stages of surgery. However, a perforator-based flap is more versatile and allows freedom in flap design. We introduced our experience with reconstruction using a facial artery perforator-based propeller flap on the perinasal area. We describe the surgical differences between different defect subtypes. Methods Between December 2005 and August 2013, 10 patients underwent perinasal reconstruction in which a facial artery perforator-based flap was used. We divided the perinasal defects into types A and B, according to location. The operative results, including flap size, arc of rotation, complications, and characteristics of the perforator were evaluated by retrospective chart review and photographic evaluation. Results Eight patients were male and 2 patients were female. Their mean age was 61 years (range, 35-75 years). The size of the flap ranged from $1cm{\times}1.5cm$ to $3cm{\times}6cm$. Eight patients healed uneventfully, but 2 patients presented with mild flap congestion. However, these 2 patients healed by conservative management without any additional surgery. All of the flaps survived completely with aesthetically pleasing results. Conclusions The facial artery perforator-based flap allowed for versatile customized flaps, and the donor site scar was concealed using the natural nasolabial fold.

• Archives of Plastic Surgery
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• 제47권3호
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• pp.209-216
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• 2020

Background Perforator flaps have led to a revolution in reconstructive surgery by reducing donor site morbidity. However, many surgeons have witnessed partial flap necrosis. Experimental methods to increase inflow have relied on adding a separate pedicle to the flap. The aim of our study was to experimentally determine whether increasing blood flow in the perforator pedicle itself could benefit flap survival. Methods In 30 male Lewis rats, an extended posterior thigh perforator flap was elevated and the pedicle was dissected to its origin from the femoral vessels. The rats were assigned to three groups: control (group I), acute inflow (group II) and arterial preconditioning (group III) depending on the timing of ligation of the femoral artery distal to the site of pedicle emergence. Digital planimetry was performed on postoperative day (POD) 7 and all flaps were monitored using laser Doppler flowmetry perioperatively and postoperatively in three regions (P1-proximal flap, P2-middle of the flap, P3-distal flap). Results Digital planimetry showed the highest area of survival in group II (78.12%±8.38%), followed by groups III and I. The laser Doppler results showed statistically significant higher values in group II on POD 7 for P2 and P3. At P3, only group II recorded an increase in the flow on POD 7 in comparison to POD 1. Conclusions Optimization of arterial inflow, regardless if performed acutely or as preconditioning, led to increased flap survival in a rat perforator flap model.

• Archives of Plastic Surgery
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• 제47권4호
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• pp.354-359
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• 2020

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearm-based flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.74-77
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• 2013

A patient underwent reconstruction of skin and soft tissue using V-Y advancement of a superior ulnar collateral artery perforator flap after resection of the scar tissue on the upper arm. Successful flap healing was observed without complications. The medial side of the upper arm is an ideal donor site because of its thin, elastic, and hairless skin, resulting in a well-hidden scar. The elasticity of the medial side of the upper arm allows primary closure after flap elevation. The superior ulnar collateral artery perforator flap is an option for reconstruction of the upper arm.

• Archives of Plastic Surgery
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• 제43권5호
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• pp.446-450
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• 2016

Background Perineal defects are commonly encountered during the treatment of conditions such as malignancy, infectious disease, and trauma. Covering large defects in the perineal area is challenging due to its complicated anatomy and the need for functional preservation. Methods Fourteen patients who underwent reconstructive surgery with multiple perforator flaps for defects >$100cm^2$ in the perineal area were included in this retrospective cohort study. Characteristics of the perforator flap operation and postoperative outcomes were reviewed. Results Reconstruction was performed using 2 perforator flaps for 13 patients and 3 perforator flaps for 1 patient. Internal pudendal artery perforator flaps were mainly used for covering the defects. The average defect size was $176.3{\pm}61.8cm^2$ and the average size of each flap was $95.7{\pm}31.9cm^2$. Six patients had minor complications, such as wound dehiscence and partial necrosis of the flap margin, which were corrected with simple revision procedures. Conclusions Multiple perforator flaps can be used to achieve successful reconstructions of large perineal defects that are difficult to reconstruct with other coverage methods.