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J Reconstr Microsurg
DOI: 10.1055/a-2435-7531
Original Article

On a Hunt for the “True” Septocutaneous Perforator: A Histology Cross-Section Study

Martin Kubat 
1   Department of Plastic and Aesthetic Surgery, St. Anne's Faculty Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
,
Zdenek Dvorak
1   Department of Plastic and Aesthetic Surgery, St. Anne's Faculty Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
,
Dusan Zoufaly
2   First Department of Pathology, St. Anne's Faculty Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
,
Marketa Hermanova
2   First Department of Pathology, St. Anne's Faculty Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
,
Marek Joukal
3   Department of Anatomy, Medical Faculty of Masaryk University, Brno, Czech Republic
,
Geoffrey G. Hallock
4   Division of Plastic Surgery, St. Luke's Hospital, Sacred Heart Campus, Allentown, Pennsylvania
› Author Affiliations Funding The research was supported by internal grant of St. Anne University hospital and International Clinical Research Center (FNDN_IP23IPV16BXA_PN) and by grant of the Specific University Research: Evaluation of Innovative Procedures in Plastic and Reconstructive Surgery IV (MUNI/A/1610/2023).
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Abstract

Background Modern trends in reconstructive surgery involve the use of free perforator flaps to reduce the donor site morbidity. The course of perforator vessels has a great anatomic variability and demands detailed knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications to perforator nomenclature proposed by various authors resulted in confusion rather than simplification. In our study, we focused on the hypothesis that a septocutaneous perforator traverses from the given source vessel to the deep fascia adherent to but not to within the septum itself.

Methods Sixty-nine septocutaneous perforators from three different limb donor sites (lateral arm flap, anterolateral thigh flap, and radial forearm free flap) were collected from the gross pathology specimens of 14 fresh cadavers. The gross picture and the cross-sections with the histological cross-sections on different levels were examined to determine the position of the vessel to the septal tissue.

Results Of the observed 69 septal perforators, 61 (88.5%) perforators were adherent to but not within the septum. The remaining eight (12.5%) perforators passed through the septum. All these eight perforators were found in multiple different cross-section levels (2 of 19 in lateral arm flap, 3 of 27 in anterolateral thigh flap, and 3 of 23 in radial forearm free flap).

Conclusion Although septocutaneous vessels appear identical macroscopically, microscopically two types of vessels with paraseptal and intraseptal pathways are observed. The majority of these vessels are merely adherent to the septum having a paraseptal pathway, while a minority are within the septum and are “true” septocutaneous perforators. It is advisable to dissect with a piece of the septum in order to avoid damage or injury to the perforator.

Keywords

septocutaneous perforator - perforator nomenclature - paraseptal - intraseptal

Authors' Contributions

M.K. is the corresponding author and contributed to literature review, flap dissections, writing the manuscript, and data evaluation. D.Z. contributed to flap dissections, writing the manuscript, and evaluation. Z.D. and H.M. contributed to microscopical preparation and evaluation. J.M. contributed to flap dissections and establishment of the ethical protocols from donors. H.G.G. is the coauthor and contributed to literature review, writing the manuscript, correspondence with Prof. Taylor, and evaluation.


* Presented in Part at the 12th Congress, World Society for Reconstructive Microsurgery, Singapore, August 17–19, 2023.




Publication History

Received: 24 June 2024

Accepted: 04 October 2024

Accepted Manuscript online:
07 October 2024

Article published online:
05 November 2024

© 2024. Thieme. All rights reserved.

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