Direct and indirect perforator flaps: the history and the controversy.

@article{Hallock2003DirectAI,
  title={Direct and indirect perforator flaps: the history and the controversy.},
  author={Geoffrey G. Hallock},
  journal={Plastic and reconstructive surgery},
  year={2003},
  volume={111 2},
  pages={
          855-65; quiz 866
        }
}
  • G. Hallock
  • Published 1 February 2003
  • Medicine
  • Plastic and reconstructive surgery
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Recognize the major role of the vascular supply to a cutaneous flap. 2. Predict its reliability. 3. Understand basic schemes for classification. 4. Realize that the evolution of these concepts is an ongoing dynamic process. Currently, the vascular supply to the fascial plexus is considered the factor of greatest importance in ensuring the reliability of any skin-bearing flap. The multiplicity of origins of… 
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Perforator Flaps: History, Controversies, Physiology, Anatomy, and Use in Reconstruction
TLDR
Perforator flaps have the advantages of reduced donor-site morbidity, versatility to accurately replace the components required at the recipient site, a longer pedicle than is achievable with the parent musculocutaneous flap, and freedom from orientation of the pedicle.
What Should Define a “Perforator Flap”?
TLDR
The authors would like to propose enriching the standard Gent nomenclature with optional terms that specify additional aspects of the perforator flap such as including the vessel of origin, the type of vascular dissection, the muscle involved, and thetype of perforATOR vessel.
The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction
TLDR
Extended knowledge of vascular anatomy has propagated the development of perforator flaps, which preserve muscle function and reduce morbidity, and highlight traditional and evolving concepts and modifications of contemporary and traditional flaps that are changing reconstructive practice.
The "Gent" Consensus on Perforator Flap Terminology: Preliminary Definitions
TLDR
In this important article, Phillip Blondeel and his coworkers have made a major contribution with their attempt to clarify and simplify, by consensus, the terminology that often has been confusing when different authors have described their various “perforator flaps.
Free Tissue Transfers and Replantation
TLDR
The indications, technique, and results of free flap reconstruction and replantation of an amputated extremity offers a result that is usually superior to any other type of reconstruction.
Guiding Local Perforator Flaps with Preoperative Imaging: Revealing Perforator Anatomy to Improve Flap Design
TLDR
“image-guided” perforator flaps that are truly axial-pattern in terms of their arterial supply can be designed with the use of preoperative imaging, and ramification patterns are presented and potential improvements to nomenclature schemes suggested.
Branch-Based Conjoined Perforator Flaps
  • G. Hallock
  • Medicine
    Plastic and reconstructive surgery
  • 2008
TLDR
Multiple direct or indirect perforator flaps from adjacent territories can be reliably combined as conjoined flaps based on sizable subfascial and/or axial vascular branches.
Perforator-Plus Flaps: A New Concept in Traditional Flap Design
  • S. Mehrotra
  • Medicine
    Plastic and reconstructive surgery
  • 2007
TLDR
The perforator-plus flap appears to be a versatile and reliable option in lower limb injuries and other diverse indications, in both the emergency and the elective settings.
Further Clarification of the Nomenclature for Compound Flaps
  • G. Hallock
  • Medicine
    Plastic and reconstructive surgery
  • 2006
TLDR
This revised nomenclature system for compound flaps is intended to be a means of standardizing communication and to facilitate research agendas on a common ground, fully realizing its primary role still only to serve as a convenient guideline.
Why not indirect nonmuscle perforator flaps?
  • G. Hallock
  • Medicine
    Plastic and reconstructive surgery
  • 2006
It is almost impossible to pick up any respectable plastic surgery journal today without finding at least one article about “perforator” flaps.1–3 Since “flaps,” as we call them, are a basic building…
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References

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TLDR
40 cases where perforator-based V-Y advancement flaps have been used to cover large defects of the lower leg following excision of malignant skin lesions and in selected trauma cases that do not involve degloving injuries are described.
Clinical Scrutiny of the de Facto Superiority of Proximally Versus Distally Based Fasciocutaneous Flaps
  • G. Hallock
  • Medicine
    Plastic and reconstructive surgery
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TLDR
The choice for any of these local fasciocutaneous flap always followed a careful assessment of the status of the fascial plexus adjacent to any defect, thereby ensuring a reasonable success rate regardless of pedicle orientation.
The Fallacy of Presumed Superiority of Proximally Based versus Distally Based Flaps
  • G. Hallock
  • Medicine
    Plastic and reconstructive surgery
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TLDR
The major factor in determining flap viability was not whether its pedicle was proximally or distally based but rather the origin and quality of its intrinsic blood supply.
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TLDR
The results of this study establish an anatomical basis for using large fasciocutaneous perforators in the design of lower leg fascial flaps.
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TLDR
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TLDR
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TLDR
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