Combined flaps serve a unique niche when significant or multidimensional defects need to be corrected. 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.
Combined flaps based on perforators, as with any other combined flaps, can be classified into two major subtypes. These in turn may be further subdivided into various subcategories according to their inherent pattern of circulation and whether this is indigenous or naturally occurring, or must be intentionally fabricated using microsurgical techniques.
The two major subdivisions of combined perforator flaps are conjoined or chimeric perforator flaps. Conjoined perforator flaps incorporate “multiple perforasomes, each dependent due to a common physical junction, with each perforasome supplied by an independent perforator.” Chimeric perforator flaps consist of multiple cutaneous territories, involving “multiple perforasomes, each supplied by an independent perforator, and independent of any physical connection with other perforasomes except where the perforators are linked to a common vascular source.”
As the anatomical knowledge of the vascular basis and technical refinements improves the overall utilization of perforator flaps, their selection as combined flaps will also assume a more definitive role. A standardization and clarification of a schema for the nomenclature for such combined perforator flaps therefore needs to be continually updated to enhance communication and surgical capabilities, reflecting the evolution of the concept of perforator flaps itself.
Allentown and Bethlehem, Pa.
From the Division of Plastic Surgery, Sacred Heart Hospital and The Lehigh Valley Hospital, and St. Luke's Hospital.
Received for publication February 27, 2010; accepted August 2, 2010.
Presented at the Fifth Congress of the World Society for Reconstructive Microsurgery, in Okinawa, Japan, June 25, 2009; the First Tokyo Meeting on Perforator and Propeller Flaps, in Tokyo, Japan, June 28, 2009; and the Fourth National Congress of the Turkish Society of Reconstructive Microsurgery, in Antalya, Turkey, December 18, 2009.
Disclosure:The author has no financial interest to declare in relation to the content of this article.
Geoffrey G. Hallock, M.D.; 1230 South Cedar Crest Boulevard; Suite 306; Allentown, Pa. 18103; email@example.com