perforatorbased

Perforatorbased is a term used in reconstructive surgery to describe a type of flap whose blood supply depends on a single cutaneous perforator vessel that traverses from a deep vascular source to the skin and subcutaneous tissues. The flap is designed around this perforator, which may be solitary or multiple, and can be islanded on its vascular pedicle. The concept emphasizes sparing muscle and other deeper tissues, reducing donor-site morbidity.

Common applications include fasciocutaneous or adipofascial flaps used for coverage after oncologic resections, trauma, or deformity correction. Well-known examples include the anterolateral thigh perforator flap, the radial forearm perforator flap, and the deep inferior epigastric perforator flap used in breast reconstruction. Perforator-based flaps can be pedicled or transferred as free flaps. Preoperative mapping with Doppler ultrasound or CT angiography aids perforator localization; intraoperative dissection isolates the perforator while preserving surrounding tissue.

Advantages include tailored flap design, reduced functional deficit at the donor site, and versatility for contouring. Risks involve perforator injury, venous congestion, or partial flap necrosis; success depends on accurate perforator identification and the use of suitable microsurgical or pedicled techniques.