J Reconstr Microsurg 2010; 26(8): 539-545
DOI: 10.1055/s-0030-1262947
© Thieme Medical Publishers

Dominance between Angiosome and Perforator Territories: A New Anatomical Model for the Design of Perforator Flaps

Warren M. Rozen1 , Damien Grinsell1 , Isao Koshima2 , Mark W. Ashton1
  • 1Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Victoria, Australia
  • 2Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Further Information

Publication History

Publication Date:
16 July 2010 (online)

ABSTRACT

An understanding of the angiosome of a source vessel in supply to a perforator flap is essential to flap design. With substantial interindividual variability in the size and reliability of such territories, preoperative awareness of factors that affect the number or size of perforators in a given territory can aid operative planning. Body weight and scarring are known to modify a given territory, and anecdotally so too can the “dominance” of adjacent vascular territories. A clinical study of 300 patients (600 body sides) was undertaken, using computed tomographic angiography, to map the vessels of six vascular territories. The effect of interplay between vascular territories was assessed by establishing whether a dominant territory was associated with a diminutive adjacent territory. For every vascular territory investigated, the effect of “dominance” was evident, with a statistically significant effect shown between the deep inferior epigastric artery and superficial inferior epigastric artery territories (p < 0.01), and the anteromedial thigh and anterolateral thigh perforator territories (p = 0.01). The size or dominance of perforators in a given vascular territory is influenced by the dominance of adjacent vascular territories. This concept of perforator or angiosome dominance is an important factor in the design of perforator flaps.

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Warren M RozenM.B.B.S. B.Med.Sc. P.G.Dip.Surg.Anat. 

Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology

The University of Melbourne, Parkville, Victoria 3050, Australia

Email: warrenrozen@hotmail.com

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