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Introduction and background

Authors: Rami Mossad Ibrahim, Magnus Obinah, Magnus Balslev Avnstorp MD, Peter Stemann, Birgitte Jul Kiil and Christian Kaare Paaskesen Med. Stud.

In this chapter you will learn the basic principles about perforator flaps, the nomenclature, the pre-operative patient assessment, and get an overview of the procedure by clinical photos and illustrations.


In 1989 Koshima and Soeda published the first case report on perforator flaps for reconstruction in two patients. They isolated a cutanous flap based on the inferior epigastric artery for successful reconstruction of a large groin defect in the oral floor, leaving the rectus abdominis muscle intact. Since then several other perforator flaps have been found and used for reconstruction.


Perforator flap: A flap based on an isolated vascularized pedicle arising from the deep vascular system. A perforator flap normally consists of skin and/or subcutaneous fat tissue, but may consist of only scarpa’s fascia and subcutaneous fat tissue. The perforators may course either through or in between the deep tissues such as muscle.


The 29th of September 2001, a consensus meeting was held in Gent, Belgium.

Perforator flaps were categorized as follows:

  1. Free perforator flaps (Dissected using microsurgery techniques)
  2. Pedicled perforator flaps
    1. Transposition flaps
    2. Propeller flaps (90-180 degree rotation flaps)