The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction.
OBJECTIVE
After studying this article, the participant should be able to: 1. Understand the history and physiology of perforator flaps. 2. Understand the concept of "free-style" perforator flaps and principles in design and harvest. 3. Understand the uses of perforator flaps in reconstruction and applications in new settings. 4. Understand new principles in single and multiple perforator flap harvest and adjunct techniques that can be used in perforator flaps. 5. Highlight pertinent anatomy and techniques for selected perforator flaps described.


CONCLUSIONS
Extended knowledge of vascular anatomy has propagated the development of perforator flaps, which preserve muscle function and reduce morbidity. This has been achieved through the exemplary works of Manchot, Salmon, Milton, Taylor, and many others. With over 350 clinically relevant perforators in the body, this has created new flap options and a sense of creative freedom for reconstruction tailored toward a specific defect, without constraints of specific landmarks and using a "free-style" approach. Dominant perforators may be found in zones of high perforator density or "hot spots," which can help to conceptualize local flap options and aid flap design. This article aims to outline the history, physiology, and principles of flap design and harvest, and highlight traditional and evolving concepts and modifications of contemporary and traditional flaps that are changing reconstructive practice. This is a broad overview focusing on clinical applications, highlighting key concepts in a selection of new or evolving flaps being used in clinical practice and providing source references to acquire detailed flap descriptions.
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Anita T
AT
Mohan
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Yoo Joon
YJ
Sur
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Lin
L
Zhu
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Mohamed
M
Morsy
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Peter S
PS
Wu
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Steven L
SL
Moran
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Samir
S
Mardini
Rochester, Minn.; Middlesex and Cambridge, United Kingdom; Seoul, Republic of Korea; and Assiut, Egypt.|From the Division of Plastic Surgery, Mayo Clinic; Restoration of Appearance and Function Charitable Trust; Department of Surgery, University of Cambridge; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; and the Department of Orthopedics, Assiut University.
Michel
M
Saint-Cyr
D058752:Free Tissue Flaps / Q000098:blood supply / Q000502:physiology / Q000637:transplantation; D006801:Humans; D061525:Perforator Flap / Q000098:blood supply / Q000502:physiology / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*
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