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Lokale Perforatorlappen

Local perforator flaps

  • Leitthema
  • Published:
Trauma und Berufskrankheit


Lokale Lappenplastiken sind seit Jahrhunderten ein Operationsverfahren zur Rekonstruktion von Gewebedefekten. Obwohl schon vor mehr als 2000 Jahren mit der so genannten indischen Lappenplastik eine kutane Lappenplastik zur Nasenrekonstruktion durchgeführt wurde, wurden erst in der 2. Hälfte des 20. Jahrhunderts gezielt Lappenplastiken mit axialer Blutversorgung für Anwendungen in der rekonstruktiven Chirurgie beschrieben. Detaillierte Kenntnisse der Blutversorgung der Haut führten schließlich zur Entwicklung von Lappenplastiken, deren Durchblutung lediglich aus vertikal aufsteigenden Perforansgefäßen stammt. Diese so genannten Perforatorlappenplastiken wurden zunächst v. a. als mikrochirurgische freie Lappenplastiken eingesetzt, jedoch erlaubt die Stielung an einzelnen Perforansgefäßen auch den sicheren und effizienten Transfer großer Gewebseinheiten als lokale Lappenplastik in die entsprechende Defektregion. Im vorliegenden Beitrag sollen Techniken der lokalen Perforatorlappenplastik sowie verschiedene regionale Anwendungsmöglichkeiten dargestellt und Indikationen und mögliche Kontraindikationen herausgearbeitet werden.


Local flaps are established procedures for reconstruction of skin and soft tissue defects. Although a cutaneous flap (the so-called Indian flap) had been applied more than 2000 years ago for reconstruction of nasal defects, axial pattern skin flaps for applications in reconstructive surgery were mainly developed in the second half of the twentieth century. Detailed knowledge of the vascular anatomy of the skin eventually led to development of a novel type of skin flap that entirely relies on perforating vessels. In the beginning these so-called perforator flaps were mainly used as microsurgical free flaps. However, the same concept also allows for safe and efficient transfer of large tissue volumes into given defects as a local pedicled flap. This article describes different technical aspects of local perforator flaps and provides examples for clinical applications in different regions. Specific Indications and contraindications of local perforator flaps are discussed in detail.

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  1. Ahmadzadeh R, Bergeron L, Tang M et al (2007) The posterior thigh perforator flap or profunda femoris artery perforator flap. Plast Reconstr Surg 119:194–201

    Article  PubMed  CAS  Google Scholar 

  2. Angrigiani C, Grilli D, Siebert J (1995) Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 96:1608–1614

    Article  PubMed  CAS  Google Scholar 

  3. Angrigiani C, Grilli D, Thorne CH (2001) The adductor flap: a new method for transferring posterior and medial thigh skin. Plast Reconstr Surg 107:1725–1731

    Article  PubMed  CAS  Google Scholar 

  4. Arco G, Horch RE, Arkudas A et al (2009) Double pedicled perforator flap to close flank defects: an alternative for closure of a large lumbar defect after basalioma excision – a case report and review of the literature. Ann Plast Surg 63:422–424

    Article  PubMed  CAS  Google Scholar 

  5. Bailey SH, Saint-Cyr M, Wong C et al (2010) The single dominant medial row perforator DIEP flap in breast reconstruction: three-dimensional perforasome and clinical results. Plast Reconstr Surg 126:739–751

    Article  PubMed  CAS  Google Scholar 

  6. Blondeel N, Vanderstraeten GG, Monstrey SJ et al (1997) The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 50:322–330

    Article  PubMed  CAS  Google Scholar 

  7. Blondeel PN, Beyens G, Verhaeghe R et al (1998) Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 51:202–209

    Article  PubMed  CAS  Google Scholar 

  8. Blondeel PN, Van Landuyt KH, Monstrey SJ et al (2003) The „Gent“ consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 112:1378–1383; 1516

    Article  PubMed  Google Scholar 

  9. Giunta RE, Geisweid A, Feller AM (2000) The value of preoperative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg 105:2381–2386

    Article  PubMed  CAS  Google Scholar 

  10. Hamdi M, Van Landuyt K, De Frene B et al (2006) The versatility of the inter-costal artery perforator (ICAP) flaps. J Plast Reconstr Aesthet Surg 59:644–652

    Article  PubMed  Google Scholar 

  11. Hamdi M, Salgarello M, Barone-Adesi L et al (2008) Use of the thoracodorsal artery perforator (TDAP) flap with implant in breast reconstruction. Ann Plast Surg 61:143–146

    Article  PubMed  CAS  Google Scholar 

  12. Innocenti M, Baldrighi C, Delcroix L et al (2009) Local perforator flaps in soft tissue reconstruction of the upper limb. Handchir Mikrochir Plast Chir 41:315–321

    Article  PubMed  CAS  Google Scholar 

  13. Jiga LP, Barac S, Taranu G et al (2010) The versatility of propeller flaps for lower limb reconstruction in patients with peripheral arterial obstructive disease: initial experience. Ann Plast Surg 64:193–197

    Article  PubMed  CAS  Google Scholar 

  14. Kato H, Hasegawa M, Takada T et al (1999) The lumbar artery perforator based island flap: anatomical study and case reports. Br J Plast Surg 52:541–546

    Article  PubMed  CAS  Google Scholar 

  15. Kim YS, Lew DH, Roh TS et al (2009) Inferior gluteal artery perforator flap: a viable alternative for ischial pressure sores. J Plast Reconstr Aesthet Surg 62:1347–1354

    Article  PubMed  Google Scholar 

  16. Kneser U, Beier JP, Dragu A et al (2010) Transverse cervical artery perforator propeller flap for reconstruction of supraclavicular defects. J Plast Reconstr Aesthet Surg Dec 3. [Epub ahead of print]

  17. Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42:645–648

    Article  PubMed  CAS  Google Scholar 

  18. Manchot C (1889) Die Hautarterien des menschlichen Körpers. FCW Vogel, Leipzig

  19. Newman TM, Vasile J, Levine JL et al (2010) Perforator flap magnetic resonance angiography for reconstructive breast surgery: a review of 25 deep inferior epigastric and gluteal perforator artery flap patients. J Magn Reson Imaging 31:1176–1184

    Article  PubMed  Google Scholar 

  20. Pignatti M, Ogawa R, Hallock Gg et al (2011) The „Tokyo“ consensus on propeller flaps. Plast Reconstr Surg 127:716–722

    Article  PubMed  CAS  Google Scholar 

  21. Rozen WM, Ribuffo D, Atzeni M et al (2009) Current state of the art in perforator flap imaging with computed tomographic angiography. Surg Radiol Anat 31:631–639

    Article  PubMed  Google Scholar 

  22. Saint-Cyr M, Schaverien MV, Rohrich RJ (2009) Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg 123:132e–145e

    Article  PubMed  CAS  Google Scholar 

  23. Saint-Cyr M, Wong C, Schaverien M et al (2009) The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 124:1529–1544

    Article  PubMed  CAS  Google Scholar 

  24. Salmon M (1936) Arteres de la peau. Masson et Cie, Paris

  25. Schaverien MV, Hamilton SA, Fairburn N et al (2010) Lower limb reconstruction using the islanded posterior tibial artery perforator flap. Plast Reconstr Surg 125:1735–1743

    Article  PubMed  CAS  Google Scholar 

  26. Taylor GI (2003) The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg 30:331–342, v

    Article  PubMed  Google Scholar 

  27. Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40:113–141

    Article  PubMed  CAS  Google Scholar 

  28. Verpaele AM, Blondeel PN, Van Landuyt K et al (1999) The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores. Br J Plast Surg 52:385–391

    Article  PubMed  CAS  Google Scholar 

  29. Wei FC, Mardini S (2004) Free-style free flaps. Plast Reconstr Surg 114:910–916

    Article  PubMed  Google Scholar 

  30. Wei FC, Jain V, Celik N et al (2002) Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 109:2219–2230

    Article  PubMed  Google Scholar 

  31. Wong CH, Cui F, Tan BK et al (2007) Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg 59:672–678

    Article  PubMed  CAS  Google Scholar 

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Correspondence to U. Kneser.

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Kneser, U., Beier, J., Dragu, A. et al. Lokale Perforatorlappen. Trauma Berufskrankh 13, 77–82 (2011).

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