AAPS Home AAPS Annual Meeting
Annual Meeting Home
Program & Abstracts
Past & Future Meetings


Back to Annual Meeting Posters


A New Concept for a Safer Flap Design: The Perfusion Angle Theory
Alex Laungani, MD, Jason Primus, MS, Jodie Christner, PhD, Robert Kirchoff, MD, Niruscha Lachman, PhD, Michel Saint-Cyr, MD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE Free and pedicle perforator flaps have played a significant role and have had a major impact in the reconstructive armamentarium. The vascular territory of each single perforator has previously been coined as perforasome. Each perforasome is connected to the adjacent one via direct and indirect linking vessels. Despite our extensive experience with perforator flaps, there are still some pitfalls regarding flap design and which can lead to total or partial flap necrosis. Most notably the optimal angle of perfusion of each perforasome has not been defined and can impact overall flap survival. The purpose of the study is to define the optimal angle of perfusion of a perforasome in application for harvest and use of pedicle and free perforator flaps. We hypothesize that obtuse angles of perfusion will lead to improve flap survival in contrast to acute or narrow angles of perfusion which will result in a higher rate of potential flap necrosis and decreased vascularity.
METHODS A total of 25 anterolateral thigh flaps were scanned through a 64-slice G-electric CT scan and subjected to CT angiography after injection of the single dominant perforator with 3 cc of Omnipaque 320 contrast solution. Perforator location was set at a standard point of 5 cm from the most cephalic portion of the ALT flap and remained constant throughout the study. The perforator perfusion angle was set at 3 different angles, which were 120º, 90º, 60º. Each flap was injected with solution of Omnipaque and then first scanned with an angle of perfusion of 120º. The angle of perfusion was subsequently reduced to 90 and 60 degrees by cutting the flap, in order to see the impact of decreased perfusion angle on overall flap vascularity. With every reduction in perfusion angle, the flap was washed out with heparinized saline. Flaps were then re-injected with 3cc of Omnipaque 320 solution and rescanned at each different angle of perfusion
RESULTS Of the 25 flaps scanned, preliminary results indicated a significant reduction in perfusion of the anterolateral thigh flap as the angle of perfusion decreased. This was assessed by a reduction in the number and density of direct and indirect linking vessels within the flap.
CONSLUSION Despite wide spread use of free and pedicle perforator flaps, complication rates resulting in total or partial flap necrosis can potentially be significantly reduced by incorporating the angle of perfusion concept within flap design. In conclusion, adequate angle of perfusion incorporated within a perforator flap skin paddle design can have a major impact on flap vascularity and should be taken into consideration during flap design.


Back to Annual Meeting Posters