Direct and indirect perforator flaps: the history and the controversy.
After studying this article, the participant should be able to: 1. Recognize the major role of the vascular supply to a cutaneous flap. 2. Predict its reliability. 3. Understand basic schemes for classification. 4. Realize that the evolution of these concepts is an ongoing dynamic process. Currently, the vascular supply to the fascial plexus is considered the factor of greatest importance in ensuring the reliability of any skin-bearing flap. The multiplicity of origins of the deep fascial perforators to this plexus has led to a bewildering array of terminology intended to encompass all possible flap options. A brief review of the history of the evolution of cutaneous flaps provides insight essential in understanding a simple proposal for their classification. Because all fascial perforators course either directly from a source vessel or indirectly first through some other tissue to ultimately reach the suprafascial layer, the corresponding flaps based on any such perforators could most simply be termed either direct perforator flaps or indirect perforator flaps, respectively.
Hallock
Geoffrey G
GG
Division of Plastic Surgery, Lehigh Valley Hospitals, Allentown, Pa 18103, USA.
D005205:Fascia / Q000098:blood supply; D049673:History, 20th Century; D006801:Humans; D008833:Microcirculation / Q000601:surgery; D008866:Microsurgery / Q000379:methods*; D018482:Muscle, Skeletal / Q000098:blood supply; D012867:Skin / Q000098:blood supply / Q000294:innervation; D013524:Surgical Flaps / Q000098:blood supply* / Q000145:classification / Q000266:history; D020858:Tissue and Organ Harvesting