Geoffrey G Hallock

..As with all perforator flaps, this ensures function preservation of the intrinsic abdominal muscles to provide a reliable solution to a difficult challenge...

..Any surgeon considering a muscle perforator flap must be aware of the possibility of this tripartite system and the advantages as well as limitations of each component...

..If additional vascularized tissue coverage following this reconstruction is imperative, knowledge of all potential flap alternatives to achieve this goal becomes critical to ensure healing and reduce the risk of recurrent hernia...

..In a metachronous fashion, this would represent a sequential chimeric perforator-based free flap and proves to be yet another inherent advantage of muscle perforator flaps...

....

....

..Whether one is a "reconstructive" or "aesthetic" plastic surgeon, knowledge of these basic tenets will ensure maintenance of competency...

....

..By way of example, these can be venae comitantes of the free flap itself, or via salvage of parts using a vena comitans that accompanied a major limb source vessel...

..Several examples are given to illustrate how the complete classification of every free flap can be possible in a reproducible and highly interpretable fashion...

..If the vascular pedicles are branches of a common source vessel, even more specifically this combination would be a "branch-based [common]" conjoined flap...

..Such a combination immediately readily identifies the precise anatomical location of the flap, as well as stating exactly which vascular pedicle must be dissected...

..This has proven to be an invaluable resource as demonstrated in two clinical cases...

..This is yet another new example of branch-based chimeric flaps, where the cutaneous component is a muscle perforator flap...

..183). In summary, relative flow to these rat ventral abdomen models was directly proportional to the number of retained musculocutaneous perforators, but a single perforator only could routinely allow near-total survival...

..This has proven to be a reliable option that alone allows complete closure of the median sternotomy wound while avoiding the need for combined flaps with preservation of the rectus abdominis muscle...

....

..This is reminiscent of bygone eras, where such a feat required multiple stages over many weeks...

..Two clinical examples using the island thoracoacromial artery perforator flap prove that this can sometimes be a viable option also for head and neck reconstruction...

....

..At least theoretically, depending on the extent of intramuscular dissection, another advantage that can be applied to all perforator flaps is that the muscle can be held in reserve for sequential use as necessary...

..This prophecy has now become a reality in this first report where a superior epigastric(RECTUS ABDOMINIS) muscle perforator flap was used successfully as a local flap to close a chest defect...

....

..The anterior tibial/dorsalis pedis axis served as the usual recipient site (87.5%) for microanastomosis. Fixation hardware was retained whenever possible. All limbs were ultimately salvaged to allow reasonable ambulation...

....

..This can be a valuable adjunctive use of muscle perforator flaps for the continuous assessment of free muscle flaps or as an exteriorized flap for the monitoring of buried free flaps...

....

..Regardless of the modality employed, the efficacious harvest of a perforator flap will still require constant vigilance during its dissection due to anatomic anomalies of the course of these perforators, which is the expected norm...

..Are muscle flaps on a downhill course to obsolescence? The answer most simply is--never...

..This as a variation of the latter, if possible, not only is more expedient to implement but also better preserves the microcirculation of the muscle to ensure viability...

....

..Thus, it must be suggested that either a composite flap or a known thick muscle should be chosen initially if a permanent trouble-free outcome is to be expected...

..As with all muscle perforator flaps, no muscle need be expended. A case report illustrates the role of the MCFAP flap for creation of a neoscrotum...

..This has been achieved successfully in 2 compliant patients, and is a reasonable solution to minimize the morbidity of this otherwise important donor site...

..On an empiric basis, their salvage has been accomplished by augmenting venous drainage through alternative outflow tracts. The validity of this clinical maneuver can now best be tested in a rat DIEP flap model...

..The choice of a lower extremity muscle perforator flap for lower extremity reconstruction limited the surgical intervention and morbidity to a single body region...

..Both are alternatives to the more traditional medial gastrocnemius muscle flap and, because this is a true muscle perforator flap, function is always preserved...

..If designed as a propeller flap, this version after rotation will cover the defect and simultaneously allow direct donor-site closure to avoid the need for a skin graft...

....

....

..The orthograde pedicled anterolateral thigh muscle perforator flap should be considered as another useful alternative for any upper thigh wound if a flap is essential...

..3. Appreciate that minor technical modifications of known flaps of any type in general do not necessarily create a new category of flap...

..Over the past year, this maneuver in 4 patients has proven to be a satisfactory outpatient procedure with rapid healing, minimal complications, and ultimately full restoration of elbow motion...

..Via a tunnel leading into the chest cavity, a deepithelialized TRAM flap can readily reach basilar thoracic defects, and[U0292] thus is particularly suited as an autogenous patch for the diaphragm...

..Thus, the timing of muscle perforator flap debulking could then be critical. Although that averaged 9.1 months (range, 3-15 months) after flap transfer in this series, the observed ischemia occurred at both ends of this spectrum...

..Perforator flaps have become a new alternative for achieving this same objective. As this latter genre evolves, it is reasonable to also expect the development of combined perforator flaps...

..One patient had delayed removal of an infected plate after sternal union was achieved...

..Nevertheless, with the current state of technology, Doppler sonography remains a more rapid, convenient, and simpler method for perforator localization...

....

..Laser Doppler flowmetry provides a reasonable system for both intraoperative and post-procedure objective monitoring of the chosen tissue transfer...

..This approach has been used in 5 clinical cases, with success except once when the flap was aborted as a result of anatomic anomalies, which is always a concern with muscle perforator flaps...

..This flap was successful and provides another alternative to the resolution of complex problems needing multiple areas of both soft-tissue coverage and vascularized bone graft...

..Many plastic surgery applications have already been described facilitated by the endoscopic harvest of vein, tendon, and nerve grafts, as well as certain local or free muscle flaps...

..The dissection itself can be somewhat tedious, but it became easier with experience, making this an excellent training model for learning proper technique in the elevation of any true perforator flap...

..The central upper limb about the elbow often is conducive to coverage with specific local fascia flaps. The distal upper extremity may be best served by a free flap, as would any large wound in all upper limb regions...