A Primer of Schematics to Facilitate the Design of the Preferred Muscle Perforator Flaps

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Background:The universal adoption of muscle perforator flaps has been hampered by a lack of uniformity that would ensure the reliable harvest of the requisite vascular pedicle. Anatomical anomalies of their vascular supply are the anticipated norm, creating a conundrum inasmuch as retention of an adequate circulation is imperative to ensure the expected flap viability. Despite better preoperative assessment of the blood supply of muscle perforator flaps, including color duplex ultrasound, computed tomographic angiography, and magnetic resonance angiography, Doppler ultrasonography remains the most convenient, inexpensive, and readily available method for evaluating a potential donor site.Methods and Results:Schematics detailing the important basic anatomical features were recapitulated for the four most prevalent muscle perforator flaps: the lateral circumflex femoral artery perforator–vastus lateralis (sic, anterolateral thigh), the deep inferior epigastric artery perforator, the superior gluteal artery perforator, and the thoracodorsal artery perforator flaps. They were also done for five other useful lower-extremity donor sites: the inferior gluteal artery perforator, the lateral circumflex femoral artery perforator–tensor fasciae latae, the medial circumflex femoral artery perforator–gracilis, the profunda femoris artery perforator–adductor magnus, and the medial sural artery perforator flaps.Conclusions:A general knowledge of the relationship of pertinent musculocutaneous perforators to certain anatomical landmarks is still relevant as a starting point for identifying their location by Doppler ultrasonography. These schematics are only rudimentary guidelines for the subsequent design of the desired flap and should in no way be construed as a definitive review of the technique nor indications for these flaps.

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