Perforator chimerism for the reconstruction of complex defects: A new chimeric free flap classification system

Title
Perforator chimerism for the reconstruction of complex defects: A new chimeric free flap classification system
Authors
김연환
Keywords
Perforator flap; Free tissue flap; Reconstructive surgical procedures; Plastic surgery; Microsurgery
Issue Date
2015-11
Publisher
ELSEVIER SCI LTD
Citation
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, v. 68, NO 11, Page. 1556-1567
Abstract
Complex defects present structural and functional challenges to reconstructive surgeons. When compared to multiple free flaps or staged reconstruction, the use of chimeric flaps to reconstruct such defects have many advantages such as reduced number of operative procedures and donor site morbidity as well as preservation of recipient vessels. With increased popularity of perforator flaps, chimeric flaps' harvest and design has benefited from 'perforator concept' towards more versatile and better reconstruction solutions. This article discusses perforator based chimeric flaps and presents a practice based classification system that incorporates the perforator flap concept into "Perforator Chimerism". The authors analyzed a variety of chimeric patterns used in 31 consecutive cases to present illustrative case series and their new classification system. Accordingly, chimeric flaps are classified into four types. Type I: Classical Chimerism, Type II: Anastomotic Chimerism, Type III: Perforator Chimerism and Type IV Mixed Chimerism. Types I on specific source vessel anatomy whilst Type II requires microvascular anastomosis to create the chimeric reconstructive solution. Type III chimeric flaps utilizes the perforator concept to raise two components of tissues without microvascular anastomosis between them. Type IV chimeric flaps are mixed type flaps comprising any combination of Types I to III. Incorporation of the perforator concept in planning and designing chimeric flaps has allowed safe, effective and aesthetically superior reconstruction of complex defects. The new classification system aids reconstructive surgeons and trainees to understand chimeric flaps design, facilitating effective incorporation of this important reconstructive technique into the armamentarium of the reconstruction toolbox. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
URI
http://www.sciencedirect.com/science/article/pii/S1748681515003356?via%3Dihubhttp://hdl.handle.net/20.500.11754/29150
ISSN
1748-6815; 1878-0539
DOI
http://dx.doi.org/10.1016/j.bjps.2015.07.004
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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