Dominance between angiosome and perforator territories: a new anatomical model for the design of perforator flaps.
An understanding of the angiosome of a source vessel in supply to a perforator flap is essential to flap design. With substantial interindividual variability in the size and reliability of such territories, preoperative awareness of factors that affect the number or size of perforators in a given territory can aid operative planning. Body weight and scarring are known to modify a given territory, and anecdotally so too can the "dominance" of adjacent vascular territories. A clinical study of 300 patients (600 body sides) was undertaken, using computed tomographic angiography, to map the vessels of six vascular territories. The effect of interplay between vascular territories was assessed by establishing whether a dominant territory was associated with a diminutive adjacent territory. For every vascular territory investigated, the effect of "dominance" was evident, with a statistically significant effect shown between the deep inferior epigastric artery and superficial inferior epigastric artery territories (p < 0.01), and the anteromedial thigh and anterolateral thigh perforator territories (p = 0.01). The size or dominance of perforators in a given vascular territory is influenced by the dominance of adjacent vascular territories. This concept of perforator or angiosome dominance is an important factor in the design of perforator flaps.
Rozen
Warren M
WM
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Victoria, Australia. warrenrozen@hotmail.com
Grinsell
Damien
D
Koshima
Isao
I
Ashton
Mark W
MW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery; D015331:Cohort Studies; D003287:Contrast Media; D019074:Epigastric Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000637:transplantation; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D008953:Models, Anatomic; D011300:Preoperative Care / Q000379:methods; D017568:Rectus Abdominis / Q000033:anatomy & histology / Q000098:blood supply*; D013524:Surgical Flaps / Q000098:blood supply*; D013848:Thigh / Q000033:anatomy & histology / Q000098:blood supply; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D003287:Contrast Media