As microvascular techniques continue to improve, perforator flap free tissue transfer is now the gold standard for autologous breast reconstruction. Various options are available for breast reconstruction with autologous tissue. These include the free transverse rectus abdominis myocutaneous (TRAM) flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, supe...

It is over 20 years since the inaugural deep inferior epigastric perforator (DIEP) flap breast reconstruction. We review the type of flap utilized and indications in 2,850 microvascular breast reconstruction over the subsequent 20 years in the senior author's practice (Robert J. Allen). Data were extracted from a personal logbook of all microsurgical free flap breast reconstructions performed b...

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. The inferior gluteal artery perforator (I...

In the 1990s, skin island flaps supplied by the vascular axis of sensitive superficial nerves, like the sural and saphenous nerves, were introduced. Flaps supplied by the superficial peroneal nerve accessory artery (SPNAA), however, are still not commonly used. The aim of this study is to understand the anatomical structure of the SPNAA and its perforators in the anterior intermuscular septum, ...

BACKGROUND The extended deep inferior epigastric perforator (DIEP) artery flap had been described in 1983. For head and neck reconstruction, we have been using a variation of this flap, namely a perforator free flap of the deep inferior epigastric system with a superolateral extension of the skin paddle. METHODS The purpose of this study was to present our 10-year experience in the performanc...

Perforator flaps allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor site morbidity. For breast reconstruction, the abdomen typically is our primary choice as a donor site. The deep inferior epigastric perforator (DIEP) flap remains our first choice as an abdominal perforator flap and has become a mainstay for the repair of mastectomy defects. It allows ...

Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and eas...

With an aging population, free flap reconstruction for head and neck cancer ablation in the elderly is becoming more commonplace. In nonagenarians, however, such major operations are still rarely offered due to its physiological demands. We report the first case of successful resection and reconstruction of head and neck cancer with a free perforator flap in a 96 year old patient. We feel that ...

Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive soft tissue sarcomas with a high rate of recurrence and metastasis. Limb salvage surgery free flap reconstruction is viable option for selected patients MPNSTs, but careful consideration should be given to the risk recurrence. This case report describes 26-year-old male patient recurrent, aggressive, high-grade MPNST who und...