Perforator flaps in lower extremity reconstruction

Perforator flaps are defined as skin flap without fascia or muscle and they are nourished by one or more perforating vessels perforating the fascia, muscle, or intermuscular septum. As early as 1985 in Japan, we proposed this concept over that of the fasciocutaneous flap, which was believed to be nourished by fascial plexus. The pedicle perforators are classified as septocutaneous, musclular (intermuscular), periosteal, and intertendinous perforators. As useful perforator flaps in the lower extremity, posterior tibial perforator island flaps, saphenous island flaps, peroneal island flaps, malleolar island perforator flaps, deep inferior epigastric perforator free flap (DIEP flap), anterolateral thigh free flap (ALT flap), and latissimus dorsi muscle free perforator flap (thoracodorsal artery perforator flap, T-DAP or TAP flap) were described. These flaps have the advantage of minimal donor-site morbidity, relatively rapid dissection and flap elevation, and reliable skin territory.