Perforator

A perforator is a blood vessel or other structure that passes through a barrier such as fascia or muscle to supply an area of tissue. In human anatomy, perforators typically originate from a deeper artery or vein and traverse to reach the overlying skin or subcutaneous tissue.

Perforators can be arterial or venous. Those supplying the skin are commonly referred to as cutaneous perforators and are classified as musculocutaneous or septocutaneous depending on their path through muscle.

In reconstructive surgery, perforator vessels are critical. Perforator flaps use a single reliable perforator to vascularize a skin or composite tissue flap, allowing tissue transfer with reduced damage to underlying muscles. Well-known examples include the DIEP (deep inferior epigastric perforator) flap and the profunda femoris perforator flap.

Localization and planning rely on imaging and intraoperative assessment. Preoperative techniques include handheld Doppler ultrasound, CT angiography, or MR angiography to map perforator locations and calibers; intraoperatively, careful dissection preserves the perforator’s vessel.

Although most commonly discussed in medical contexts, the term perforator can also describe any device or structure that makes perforations in material, such as a tool used to puncture or create holes. In medicine, the emphasis is on the vessel’s passage through surrounding tissues to reach its target area.