Abstract
Perforator flaps based on either musculocutaneous or septocutaneous perforators are
no longer a curiosity, but rather in the past decade have become “workhorse” soft
tissue alternatives. Yet a keener understanding of their anatomy abetted by sophisticated
imaging techniques has revealed other deep fascia perforators whose potential impact
should not be overlooked. An important triad of these perforators can be found to
arise ultimately from the source vessel to a muscle. This triumvirate includes the
well-known, almost insignificant, capillary-like musculocutaneous perforator and the
larger-caliber and often dominant musculocutaneous perforator that has become the
basis of the conventional muscle perforator flap. An overlooked member of this tripartite
system, though, is the direct cutaneous branch from the muscle hilum, which may be
far more common than previously realized. The latter typically takes a paramuscular
or extramuscular course to the skin, so that its corresponding perforator flap can
be raised most simply while totally avoiding entering any muscle substance per se,
and thus by definition will best ensure function preservation. Any surgeon considering
a muscle perforator flap must be aware of the possibility of this tripartite system
and the advantages as well as limitations of each component.
Keywords
muscle perforator flap - direct cutaneous muscle vessel perforator - musculocutaneous
perforator
