Background: Perforator flaps represent the latest in the evolution of soft-tissue flaps. They allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor-site morbidity. The powerful perforator flap concept allows transfer of tissue from numerous, well-described donor sites to almost any distant site with suitable recipient vessels. Large-volume flaps can be reliably supported with perforators from areas such as the buttock and transferred microsurgically for breast reconstruction.
Indications: The ideal tissue for breast reconstruction is fat with or without skin, not implants or muscle. Absolute contraindications specific to perforator flaps in our practice include history of previous liposuction of the donor site, some previous donor-site surgery, or active smoking (within 1 month before surgery).
Methods: Perforator flaps are supplied by blood vessels that arise from named, axial vessels and perforate through or around overlying muscles and septa to vascularize the overlying skin and fat. During flap harvest, these perforators are meticulously dissected free from the surrounding muscle, which is spread in the direction of the muscle fibers and preserved intact. The pedicle is anastomosed to recipient vessels in the chest, and the donor site is closed without the use of synthetic mesh.
Conclusion: Perforator flaps allow for safe, reliable tissue transfer from a variety of sites and provide ideal tissue for breast reconstruction, with minimal donor-site morbidity.