Perforator flaps and supermicrosurgery.
The introduction of supermicrosurgery, which allows the anastomosis of smaller caliber vessels and microvascular dissection of vessels ranging from 0.3 to 0.8mm in diameter, has led to the development of new reconstructive techniques. New applications of this technique are for crushed fingertip replantations with venule grafts, toe tip transfers for fingertip loss, partial auricular transfers for total tracheal and eyelid defects, and lymphaticovenular anastomoses under local anesthesia for lymphedema. Regarding free flaps, free perforator-to-perforator flaps, including deep inferior epigastric perforator or paraumbilical perforator flaps, gluteal artery perforator flaps, thoracodorsal artery perforator flaps, anterolateral thigh perforator flaps, superficial circumflex iliac artery perforator flaps, tensor fasciae lata perforator flaps, and medial plantar perforator flaps, with a short pedicle, have been used for extremity and facial defects. The success rate is almost the same as that of usual free flap transfers with large and long pedicles. The advantages of these flaps are the simple operation and the short time needed for flap elevation, plus the fact that the flaps can be obtained from anywhere in concealed areas. The disadvantages are the need for supermicrosurgical technique and the anatomic variation of these perforators.
Koshima
Isao
I
Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. koushimai-pla@h.u-tokyo.ac.jp
Yamamoto
Takumi
T
Narushima
Mitsunaga
M
Mihara
Makoto
M
Iida
Takuya
T
D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery; D000714:Anastomosis, Surgical; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D005383:Finger Injuries / Q000601:surgery; D006801:Humans; D008297:Male; D008413:Mastitis / Q000209:etiology / Q000601:surgery; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010307:Parotid Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*