A PRIMER OF SCHEMATICS FOR SIMPLIFYING THE DESIGN OF THE COMMON MUSCLE PERFORATOR FLAPS
Geoffrey G. Hallock, MD.
Lehigh Valley and Sacred Heart Hospitals/St.Luke's Hospital, Allentown/Bethlehem, PA, USA.
Background: A muscle perforator flap can be designed about any perforator anywhere in the body. Unfortunately, the exact location of that suitable perforator can be highly variable. Evolving technology including CT angiography and MRA can sometimes be valuable in the preoperative assessment of these perforators. Nevertheless, Doppler ultrasonography still remains the most convenient, inexpensive, and globally available method to evaluate any potential donor site for perforators. Therefore, at least at the present time, it is still important to have a general knowledge of the relationship of musculocutaneous perforators to known anatomical landmarks.
Method: A review of the available world literature confirms that the 4 most prevalent muscle perforator flaps are the LCFAP-vl, DIEAP, SGAP, and TDAP flaps. In addition, 5 other useful lower extremity donor sites include the IGAP, LCFAP-tfl, MCFAP-g, PFAP-am, and MSAP flaps. Based on the typical anatomy of perforators to those flaps, schematics can be drawn as a starting point for identifying the location of their perforators.
Results: Anatomic based schematics can be helpful as an approximate guide for locating the requisite perforator(s) for the most commonly used muscle perforator flaps. These will be reviewed in detail.
Conclusion: This primer of schematics is intended to assist in the design of the most common muscle perforator flaps where Doppler ultrasonography is then used to identify the appropriate perforator. Included in this simplified collection are the LCFAP-vl, DIEAP, S&IGAP, TDAP, MCFAP-g, MSAP, LCFAP-tfl, and PFAP-am flaps.
Figure 1.: LCFAP-vl schematic.
Figure 2.: S&IGAP schematic.