An Anatomic Study of the Septocutaneous Vessels of the Leg

Carriquiry, Carlos; COSTA, Maria Aparecida; Vásconez, Luis O.

doi:10.1097/00006534-198509000-00003

Cited by 196 publications

(77 citation statements)

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“…All flaps included dominant perforator vessels defined by preoperative hand held Doppler localisation. Several authors [7,18,23] found this to be a useful technique, refining knowledge from many anatomical studies that have mapped the network of cutaneous perforating vessels [1,4,11,17,25,26]. Niranjan et al [14] routinely use the hand held Doppler to plan V-Y perforator-based flaps around a series of adjacent perforating vessels in the lower limb.…”

Section: Discussionmentioning

confidence: 99%

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Perforator-based flaps in distal upper and lower extremity defects

2002

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The reconstruction of complex distal extremity defects is challenging with both cosmetic and functional considerations. This case series reviews our experience of using perforator-based flaps in 28 patients requiring reconstruction of 30 distal extremity defects. Hand held Doppler localisation of the perforators was carried out preoperatively in all cases. Flaps used were either fasciocutaneous or adipofascial and 90% of the defects were post-traumatic. Uncomplicated closure was achieved in 22 cases, with the majority of complications being minor. Complete failure was encountered in only two cases and as such was comparable with our experience of free tissue transfer. We propose consideration of perforator based flaps as an acceptable alternative to free tissue transfer in many extremity defects and find the hand held Doppler probe to be an invaluable tool in flap planning.

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Section: Discussionmentioning

confidence: 99%

“…After Pontén described the fasciocutaneous flap in 1981 [15], a re-evaluation of the vascular anatomy of the limbs resulted in the description of a number of useful distally based variations [4,7,16]. These flaps were based on defined distally situated perforators.…”

Section: Introductionmentioning

confidence: 99%

Perforator-based flaps in distal upper and lower extremity defects

2002

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“…Near the muscular fascia in the extremities there are significant vascular plexuses which are arranged tridimensionally as a minor subfascial plexus, insignificant vessels within the fascia, and a dominant prefascial plexus [2,3]. These plexuses receive their b l o o d supply from the septocutaneous and musculocutaneous perforators.…”

Section: Discussionmentioning

confidence: 99%

The subcutaneous adipose turnover flap: successful coverage of a difficult electrical burn wound of the wrist

et al. 1995

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Skin-grafted subcutaneous adipose turnover flaps can be very useful in providing cover of exposed joints especially in critically ill patients. An exposed wrist joint due to a full-thickness electrical burn was successfully covered with a large turnover pure subcutaneous flap harvested from the forearm. Stable cover and good function with minimal donor site morbidity was achieved (22 months follow-up). The planning and the anatomical bases of this useful flap are discussed.A 42-year-old man was admitted 2 days after a severe 20-kV injury. He had extensive deep burns of the left shoulder and left thigh area. In addition, there was an area of full-thickness burn down to the bone, and joint cartilage over the right wrist, right thumb, and little finger were completely carbonized ( Fig. 1). Due to his critical general condition radical ddbridement of the right little finger and thumb amputation was delayed until the 24th postburn day. In addition, extended latissimus dorsi and trapezius musculocutaneous flaps were delayed. Twelve days later the musculocutaneous flaps were used for cover of the thoracic and right shoulder defects, split-thickness skin grafts for that of the thigh, and a subcutaneous turnover flap for that of the right wrist area (Figs. 2, 3). The musculocutaneous flaps healed uneventfully; there was a partial loss of grafts (60% on the thigh and 40% on the turnover subcutaneous flap). Ten days later repeat skin grafting was performed.The patient was discharged 62 days after the admission with a good, relatively pliable, and stable cover of the wrist joint. Fourteen months later a wrist arthrodesis and ulnar head excision reaction were performed for pain and poor wrist function (Fig. 4). A 22-month follow-up shows a satisfactory cover of the metal plate used in the arthrodesis, minimal donor site morbidity and good function of the three remaining fingers (Figs. 4, 5). Planning and surgical technique for the subcutaneous turnover flap over the exposed left wrist jointThe final area of the exposed bone and joint was 7x6 cm (Fig. 2). A K wire was inserted to allow temporary reduction of the displaced ulnar head. The flap was planned with a pedicle of 4x6 cm and a length of 22 cm (4+7 cm). A 15-cm longitudinal incision (4+4+11 cm) was performed along the midline of the flap; this extended just through the dermis (Fig. 2). Under tourniquet two very thin skin flaps were elevated in a plane just under the dermis for 3 cm, and the adipose subcutaneous flap was carefully separated with a scalpel from the muscular fascia, stopping at the limit of the pedicle (about 4 cm from the defect; Fig. 3). The subcutaneous flap was then turned over the wound and skin-grafted; the donor area was closed primari]ly. The thin skin flaps healed without problems, with a very fine scar, while the skin graft over the flap showed a partial loss (40%). A second skin graft 10 days later healed very well, providing good cover for the exposed joint. DiscussionThe main interest of this case is the use of the very large pure subcutaneous...

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“…The skin paddle is quite reliable and its blood supply is based on 2 types of perforating vessels (septocutaneous and musculocutaneous) that originate from the peroneal artery. [2][3][4] Fibular osteotomies are required during the flap harvest and for proper contouring of long segmental defects during reconstruction of the new mandible or new maxilla. Preservation of the fibular blood supply is essential during osteotomies.…”

Section: Anatomymentioning

confidence: 99%