Plastic Surgery Research Council
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TOWARDS A SAFER DESIGN OF PERFORATOR FLAPS: THE PERFUSION ANGLE THEORY
Presenter: Alexis Laungani, MD
Co-Authors: Primus J; Christner J; Lachman N; Kirchoff R; Saint-Cyr M
Mayo Clinic

Free and pedicle perforator flaps have played a significant role and have had a major impact in a reconstructive armamentarium. The vascular territory of a single perforator has previously been coined as perforasome and is interconnected to another via direct and indirect linking vessels. Despite our extensive experience with perforator flaps, there are still some pitfalls regarding flap design, which can lead to total or partial flap necrosis. Most notably, the optimal angle of perfusion of each perforasome has not been defined and can impact overall flap survival. The purpose of this study is to define the optimal angle of perfusion of perforasomes in application for harvest and use of pedicle and free perforator flaps. A total of 25 anterolateral thigh flaps were scanned through a 64-slice G-electric CT scan and subjected to CT angiography after injection of the single dominant perforator with 3 cc of Omnipaque 320 contrast solution. Perforator location was set at a standard point of 5 cm from the most cephalic portion of the ALT flap and remained constant throughout the study. The pivot angle point from the cephalic portion of the flap was set at 4 different angles, which were 120?, 90?, 60?, and 45?. Each flap was injected with solution of Omnipaque and then first scanned with an angle of perfusion of 120?. The angle of perfusion was subsequently reduced to 90, 60, and 45 degrees by cutting the flap, in order to see the impact of decreased perfusion angle on overall flap vascularity. With every reduction in perfusion angle, the flap was washed out with heparinized saline. Flaps were then re-injected with 3cc of Omnipaque 320 solution and rescanned at each different angle of perfusion. Of the 25 flaps scanned, results indicated a dramatic decrease in perfusion of the anterolateral thigh flap as the angle of perfusion decreased, which could be assessed by a reduction in the number and density of direct and indirect linking vessels. In conclusion, adequate angle of perfusion incorporated within a perforator flap design can have a major impact on flap vascularity and should be taken into consideration.


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