Perforator flaps: Current concept and definition

Angela Faga, G. Nicoletti, M. Carminati

Research output: Contribution to journalArticlepeer-review


The term "perforator flap", used to define a new type of flap, has recently been introduced in the medical field and in the clinical practice of plastic surgeons. The term however is still used incorrectly also in the literature. We agree with Wei et al. (1) who restrict the term "perforator flap" to those flaps characterized by a pedicle which is isolated through the thickness of a muscle, therefore deliberately excluding from the category of "perforator flaps" all flaps like the septocutaneous, fasciocutaneous, etc., where the pedicle does not pass "through" the actual muscle itself. On the basis of this definition we set out to revise all the current literature in order to individualize the first "true" perforator flap, and to catalog all the perforator flaps described up to now in the literature. The concept of the perforator flap was introduced by Kroll et al. (2) in 1988. They defined the first perforator flap as a "low posterior midline perforator flap" which is based on the intercostal perforating vessels of the 10th-12th thorax cavity and on the paraspinous perforating vessels of the 3rd-5th lombar region, and is used for defects in the distal part of the dorsum. Subsequently, Koshima et al. (3, 4) described in 1989 and 1993 perforator flaps based on the inferior epigastric artery and the superior gluteal artery which are commonly known as DIEP and S-GAP. Up to now a total of 11 perforator flaps have been described, considering as the latest flap the one described by Angrigiani et al. (5) in 2001 with the name "adductor flap" based on the 1st perforating vessel of the deep femoral muscle and suited for lower limb defects. The undoubted advantage that these new flaps have in the solution of particular surgical indications represents the stimulus to pursue the research that will certainly bring about descriptions of numerous new flaps of this type in a short time.

Original languageEnglish
Pages (from-to)27-32
Number of pages6
JournalRivista Italiana di Chirurgia Plastica
Issue number1-2
Publication statusPublished - 2001

ASJC Scopus subject areas

  • Surgery


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