title: Predictable Pattern Digital Artery Perforator Flap: An Alternative Concept in Digital Reconstruction.
abstract: The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their course. Their identification is performed with Doppler flowmetry. The vasculo-cutano-tendino-osseous complex (VCTOC), which was described by the senior authors, was responsible for the vascularization of all digital anatomic structures (extensor apparatus, skin, periosteum). Their consistent appearance to well measured distances from the digital joints led the way to the present clinical study for highlighting this described anatomy in-vivo and demonstrating the predictability in digital artery perforator (DAP) flap harvest.
  
  
  
  From November 2012 to March 2014, fifteen patients underwent reconstruction with a predictable pattern digital artery perforator flap (PPDAP), based on the previously described VCTOC mapping, for digital lesions secondary to tumor extirpation. Flaps were designed as V-Y advancement or propeller type. Postoperative control concerned flap viability and digital function.
  
  
  
  Seven males and 8 females underwent elective surgery using PPDAP flaps for digital defects following tumor extirpation. The diameter of the defect ranged from 0.5 to 1.5 cm. The vast majority of the lesions were identified on the right hand, the index, the ring finger and the distal phalanx. All flaps survived without signs of venous congestion. No functional digital problems were observed during follow up (mean of 77 months). A minor wound dehiscence presented in one patient.
  
  
  
  Authors introduced the concept of a "predictable pattern" in the surgery of perforator flaps in the digits. These flaps are reliable and could be a valuable reconstructive option.
authors.affiliation: Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece.
authors.forename: Epameinondas
authors.initials: E
authors.lastname: Kostopoulos
authors.affiliation: Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Agiannidis
authors.affiliation: Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Konofaos
authors.affiliation: Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece.
authors.forename: Avraam
authors.initials: A
authors.lastname: Dounavis
authors.affiliation: Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece.
authors.forename: Othon
authors.initials: O
authors.lastname: Papadopoulos
authors.affiliation: Bordeaux 2 University, Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Casoli
keywords: Doppler device; digital artery perforator flap; dorsal perforators; extensor apparatus; predictable pattern; vascular cutaneo-tendino-osseous complex