Functional perforator flap: concept and clinical applications_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIAO Hu ¹ , ZANG Mengqing ¹ , ZHOU Lu ¹ , JIN Shengyang ¹ , PAN Jiadong ² , WANG Miao ¹ , WANG Xin ² ,  LIU Yuanbo ¹

1. Department of Scar and Wound Treatment II, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P. R. China;
2. Hand Microsurgery and Reconstruction Center, Ningbo Sixth Hospital, Ningbo Zhejiang, 315043, P. R. China;

Corresponding author：

LIU Yuanbo, Email: ybpumc@sina.com

Keywords：

Perforator flap; functional perforator flap; chimeric flap; lymphatic drainage; nerve repair; flow-through flap

DOI：

10.7507/1002-1892.202507045

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the clinical applications of perforator flaps in restoring human body functions. Methods An extensive literature review was conducted on both domestic and international publications to summarize the clinical use of perforator flaps for functional restoration. Results Perforator flaps are among the most commonly used flaps in reconstructive surgery. Beyond providing soft tissue repair, they are increasingly employed to reconstruct diverse bodily functions, leading us to propose the concept of the “functional perforator flap”. Although various forms of functional perforator flaps are currently utilized, reports are predominantly scattered case studies, lacking systematic organization. Commonly used functional perforator flaps can be categorized into five types: chimeric perforator flaps, perforator flaps for nerve function restoration, perforator flaps for lymphatic drainage enhancement, flow-through perforator flaps, and perforator flaps for restoring bone and joint motion. These novel flaps significantly broaden the application scope of perforator flaps, elevating the goal of reconstruction from mere wound repair to achieving repair concurrent with functional reconstruction. Conclusion The application of various functional perforator flap designs significantly improves wound reconstruction outcomes and represents an effective approach for managing complex defects. Future developments will undoubtedly see more forms of functional perforator flaps reported to meet increasingly sophisticated reconstructive demands.

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1. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
2. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg, 1994, 32(1): 32-38.
3. Blondeel PN, Van Landuyt KH, Monstrey SJ, et al. The “Gent“ consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg, 2003, 112(5): 1378-1383.
4. 张世民, 王欣, 唐茂林, 等. 穿支皮瓣的争论与当前共识. 中华显微外科杂志, 2014, 37(1): 3-4.
5. Wang X, Mei J, Pan J, et al. Reconstruction of distal limb defects with the free medial sural artery perforator flap. Plast Reconstr Surg, 2013, 131(1): 95-105.
6. 胡浩良, 李学渊, 范学锴, 等. Free-style概念在特殊肌皮穿支型股前外侧皮瓣的应用. 中华显微外科杂志, 2019, 42(5): 477-479.
7. 杨科跃, 黄剑, 陈川, 等. 端侧吻合技术在个性化游离腹股沟皮瓣移植中的应用. 中华显微外科杂志, 2021, 44(4): 403-407.
8. 唐举玉, 章一新, 张世民, 等. 游离分叶穿支皮瓣临床应用专家共识. 中华显微外科杂志, 2024, 47(6): 601-610.
9. 潘佳栋, 王欣, 尹善青, 等. 功能性胸背动脉穿支皮瓣嵌合背阔肌游离移植重建前臂复合组织缺损13例. 中华显微外科杂志, 2024, 47(3): 241-247.
10. 王欣, 潘佳栋. 功能性穿支皮瓣的概念与应用. 中华显微外科杂志, 2024, 47(6): 611-613.
11. Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg, 1991, 27(2): 126-131.
12. Huang WC, Chen HC, Wei FC, et al. Chimeric flap in clinical use. Clin Plast Surg, 2003, 30(3): 457-467.
13. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg, 2006, 117(7): 151e-160e.
14. Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg, 2011, 127(4): 1720-1729.
15. Wu X, Yang R, Yuan Y, et al. Application of a chimeric ALT perforator flap with vastus lateralis muscle mass in the reconstruction of the defects after radical resection of a buccal carcinoma: A retrospective clinical study. J Surg Oncol, 2020, 122(4): 632-638.
16. Vieira L, Rodriguez-Lorenzo A. The role of deep inferior epigastric perforator and thoracodorsal artery perforator flaps in head and neck reconstruction. Oral Maxillofac Surg Clin North Am, 2024, 36(4): 463-474.
17. Yu Z, Jin S, Zang M, et al. Successful reconstruction of complex sacrococcygeal defects using chimeric perforator propeller flap. Ann Plast Surg, 2023, 91(5): 597-603.
18. Daar DA, Abdou SA, Cohen JM, et al. Is the medial sural artery perforator flap a new workhorse flap? A systematic review and meta-analysis. Plast Reconstr Surg, 2019, 143(2): 393e-403e.
19. Lin CH, Hsieh YH, Lin CH. The medial sural artery perforator flap in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 249-257.
20. Deek NFA, Hsiao JC, Do NT, et al. The medial sural artery perforator flap: Lessons learned from 200 consecutive cases. Plast Reconstr Surg, 2020, 146(5): 630e-641e.
21. Chu T, Xiao J, Zhou X, et al. Free chimeric superficial circumflex iliac artery perforator flap in reconstructing the distal complex extensor tendon injury. Plast Reconstr Surg, 2024, 153(2): 442e-447e.
22. Qing L, Wu P, Yu F, et al. Sequential chimeric deep circumflex iliac artery perforator flap and flow-through anterolateral thigh perforator flap for one-stage reconstruction of complex tissue defects. J Plast Reconstr Aesthet Surg, 2019, 72(7): 1091-1099.
23. Koshima I, Soeda S. Free posterior tibial perforator-based flaps. Ann Plast Surg, 1991, 26(3): 284-288.
24. Blondeel PN, Boeckx WD. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg, 1994, 47(7): 495-501.
25. Blondeel PN. The sensate free superior gluteal artery perforator (S-GAP) flap: a valuable alternative in autologous breast reconstruction. Br J Plast Surg, 1999, 52(3): 185-193.
26. Hamilton KL, Kania KE, Spiegel AJ. Post-mastectomy sensory recovery and restoration. Gland Surg, 2021, 10(1): 494-497.
27. Blondeel PN, Demuynck M, Mete D, et al. Sensory nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless? Br J Plast Surg, 1999, 52(1): 37-44.
28. Bijkerk E, van Kuijk SMJ, Lataster A, et al. Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation. Breast Cancer Res Treat, 2020, 181(3): 599-610.
29. Lin CT, Yang KC, Hsu KC, et al. Sensate thoracodorsal artery perforator flap: a focus on its preoperative design and harvesting technique. Plast Reconstr Surg, 2009, 123(1): 163-174.
30. Lin CT, Chen LW. Surgical refinements and sensory recovery of using transverse sensate thoracodorsal artery perforator flaps to resurface ring-avulsed fingers. Ann Plast Surg, 2014, 72(3): 299-306.
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