Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Application of Perforator Flap for the Oral and Maxillofacial Reconstruction

구강악안면재건을 위한 천공지 피판의 적용

  • Kim, Soung Min (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Oh, Jin Sil (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Kang, Ji Young (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Myoung, Hoon (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University) ;
  • Lee, Jong Ho (Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University)
  • 김성민 (서울대학교 치의학대학원 구강악안면외과학교실, 치학연구소) ;
  • 오진실 (서울대학교 치의학대학원 구강악안면외과학교실, 치학연구소) ;
  • 강지영 (서울대학교 치의학대학원 구강악안면외과학교실, 치학연구소) ;
  • 명훈 (서울대학교 치의학대학원 구강악안면외과학교실, 치학연구소) ;
  • 이종호 (서울대학교 치의학대학원 구강악안면외과학교실, 치학연구소)
  • Received : 2013.03.01
  • Accepted : 2013.05.15
  • Published : 2013.05.31
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Abstract

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.

Keywords

References

  1. Tolhurst DE. A comprehensive classification of flaps: the atomic system. Plast Reconstr Surg 1987;80:608-9. https://doi.org/10.1097/00006534-198710000-00023
  2. McCraw JB, Vasconez LO. Musculocutaneous flaps: principles. Clin Plast Surg 1980;7:9-13.
  3. McCraw JB. The recent history of myocutaneous flaps. Clin Plast Surg 1980;7:3-7.
  4. Mathes SJ, Nahai F. Clinical applications for muscle and musculocutaneous flaps. St. Louis: The C.V. Mosby Company; 1982.
  5. Blondeel PN, Morris SF, Hallock GG, Neligan PC. Perforator flaps: anatomy, technique & clinical applications. 2nd ed. St. Louis: Quality Medical Pub.; 2006.
  6. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42:645-8. https://doi.org/10.1016/0007-1226(89)90075-1
  7. Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 1988;81:561-6. https://doi.org/10.1097/00006534-198804000-00012
  8. Strauch B, Yu HL. Atlas of microvascular surgery; anatomy and operative approaches. 2nd ed. NewYork, Stuttgart: Thieme; 2006. p.372-87.
  9. Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications. Ann Plast Surg 2003;50:90-9. https://doi.org/10.1097/00000637-200301000-00016
  10. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994;32:32-8. https://doi.org/10.1097/00000637-199401000-00007
  11. Hallock GG. Muscle perforator flaps: the name game. Ann Plast Surg 2003;51:630-2. https://doi.org/10.1097/01.sap.0000095721.88559.a2
  12. Hallock GG. Direct and indirect perforator flaps: the history and the controversy. Plast Reconstr Surg 2003;111:855-65. https://doi.org/10.1097/01.PRS.0000040462.38363.C7
  13. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg 2006;117:151e-60e. https://doi.org/10.1097/01.prs.0000219178.20541.7f
  14. Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Watanabe A, Ishii R. Free perforator flap for the treatment of defects after resection of huge arteriovenous malformations in the head and neck regions. Ann Plast Surg 2003;51:194-9. https://doi.org/10.1097/01.SAP.0000044706.58478.73
  15. Kim JT. New nomenclature concept of perforator flap. Br J Plast Surg 2005;58:431-40. https://doi.org/10.1016/j.bjps.2004.12.009
  16. Kim YH, Kim JT. Perforator flaps in head and neck reconstruction. Hanyang Med Rev 2009;29:265-73. https://doi.org/10.7599/hmr.2009.29.3.265
  17. Hallock GG. The complete classification of flaps. Microsurgery 2004;24:157-61. https://doi.org/10.1002/micr.20035
  18. Wei FC, Celik N, Jeng SF. Application of "simplified nomenclature for compound flaps" to the anterolateral thigh flap. Plast Reconstr Surg 2005;115:1051-5. https://doi.org/10.1097/01.PRS.0000156296.74066.80
  19. Kim JT. Two options for perforator flaps in the flank donor site: latissimus dorsi and thoracodorsal perforator flaps. Plast Reconstr Surg 2005;115:755-63. https://doi.org/10.1097/01.PRS.0000152427.09893.80
  20. Yii NW, Niranjan NS. Fascial flaps based on perforators for reconstruction of defects in the distal forearm. Br J Plast Surg 1999;52:534-40. https://doi.org/10.1054/bjps.1999.3170
  21. Worseg AP, Kuzbari R, Alt A, Jahl G, Tschabitscher M, Holle J. The vertically based deep fascia turnover flap of the leg: anatomic studies and clinical applications. Plast Reconstr Surg 1997;100:1746-61. https://doi.org/10.1097/00006534-199712000-00017
  22. Wei FC, Silverman RT, Hsu WM. Retrograde dissection of the vascular pedicle in toe harvest. Plast Reconstr Surg 1995;96:1211-4. https://doi.org/10.1097/00006534-199510000-00034
  23. Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg 2003;30:473-80. https://doi.org/10.1016/S0094-1298(03)00047-6
  24. Seo MH, Kim SM, Myoung H, Lee JH. The Influence of vascular twisting on the supermicroanastomosis of superficial inferior epigastric artery. J Craniofac Surg 2013; in press.
  25. Koshima I, Moriguchi T, Fukuda H, Yoshikawa Y, Soeda S. Free, thinned, paraumbilical perforator-based flaps. J Reconstr Microsurg 1991;7:313-6.
  26. Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N. Free thin paraumbilical perforator-based flaps. Ann Plast Surg 1992;29:12-7. https://doi.org/10.1097/00000637-199207000-00004
  27. Kim JT, Kim SK. Hand resurfacing with the superthin latissimus dorsi perforator-based free flap. Plast Reconstr Surg 2003;111:366-70. https://doi.org/10.1097/00006534-200301000-00064
  28. Akizuki T, Harii K, Yamada A. Extremely thinned inferior rectus abdominis free flap. Plast Reconstr Surg 1993;91:936-41. https://doi.org/10.1097/00006534-199304001-00034
  29. Kimura N. A microdissected thin tensor fasciae latae perforator flap. Plast Reconstr Surg 2002;109:69-77. https://doi.org/10.1097/00006534-200201000-00012
  30. Kim DY, Jeong EC, Kim KS, Lee SY, Cho BH. Thinning of the thoracodorsal perforator-based cutaneous flap for axillary burn scar contracture. Plast Reconstr Surg 2002;109:1372-7. https://doi.org/10.1097/00006534-200204010-00026
  31. Imai R, Matsumura H, Tanaka K, Uchida R, Watanabe K. Comparison of Doppler sonography and multidetector-row computed tomography in the imaging findings of the deep inferior epigastric perforator artery. Ann Plast Surg 2008;61:94-8. https://doi.org/10.1097/SAP.0b013e3181561500
  32. Mun GH, Kim HJ, Cha MK, Kim WY. Impact of perforator mapping using multidetector-row computed tomographic angiography on free thoracodorsal artery perforator flap transfer. Plast Reconstr Surg 2008;122:1079-88. https://doi.org/10.1097/PRS.0b013e31818458b3
  33. Lyons AJ. Perforator flaps in head and neck surgery. Int J Oral Maxillofac Surg 2006;35:199-207. https://doi.org/10.1016/j.ijom.2005.07.015
  34. Kim SM, Seo MH, Kang JY, et al. Anatomical review of radial forearm free flap for the oral cavity reconstruction. J Korean Assoc Maxillofac Plast Reconstr Surg 2011;33:93-101.
  35. Seo MH, Kim SM, Kang JY, Myoung H, Lee JH. Anatomical review of lateral upper arm flap for the oral and maxillofacial reconstruction. J Korean Assoc Maxillofac Plast Reconstr Surg 2012;34:286-92.
  36. Kim SM, Kang JY, Eo MY, Myoung H, Lee SK, Lee JH. Anatomical review of dorsalis pedis artery flap for the oral cavity reconstruction. J Korean Assoc Oral Maxillofac Surg 2011;37:184-94. https://doi.org/10.5125/jkaoms.2011.37.3.184
  37. Park JM, Oh JS, Kim SM, Myoung H, Lee JH. Anatomical review of anterolateral thigh flap for the oral and maxillofacial reconstruction. J Korean Assoc Maxillofac Plast Reconstr Surg 2013; in press.
  38. Park JM, Seo MH, Kim SM, Kang JY, Myoung H, Lee JH. Anatomical review of rectus abdominis muscle free flap for the oral and maxillofacial reconstruction. J Korean Assoc Maxillofac Plast Reconstr Surg 2012;34:367-75.