perforators

Perforators are blood vessels that travel from a deeper source artery or vein to supply a region by penetrating the fascia and reaching the skin and subcutaneous tissues. They can move through muscle (musculocutaneous perforators) or pass more directly through connective tissue (septocutaneous perforators). In anatomy and surgery, perforators form a vascular bridge from a main vessel to the surface, enabling targeted perfusion of superficial tissues.

In clinical practice, perforator vessels are central to perforator flap techniques. These flaps are raised based on a single perforator while preserving most of the underlying muscle, which reduces donor-site morbidity. Common examples include the deep inferior epigastric perforator (DIEP) flap used in breast reconstruction and various thigh and trunk perforator flaps that rely on perforators from the lateral circumflex femoral system or other source arteries. Perforators are described by their path (musculocutaneous or septocutaneous) and by the source vessel supplying the flap.

Anatomic variability is common: perforators differ in number, size, depth, and precise location between individuals. The concept of a dominant perforator—one that provides the major share of the flap’s blood supply—helps guide surgical design. Preoperative planning often employs Doppler ultrasound, CT angiography, or other imaging to map reliable perforators and optimize incision placement.

Outside of surgery, the term perforator may also refer to devices or tools designed to create holes in materials, but in medical contexts it primarily denotes vessels that perforate fascia to perfuse the skin and subcutaneous tissues.