New nomenclature concept of perforator flap Jeong Tae Kim  British Journal of Plastic Surgery  Volume 58, Issue 4, Pages 431-440 (June 2005) DOI: 10.1016/j.bjps.2004.12.009 Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 1 New nomenclature system of the perforator flap. Perforator flap based on the DCp or SCp is named based on its proximal vessel, but the flap based on the MCp is named according to the muscle perforated. Perforator ‘based’ flap means the flap based on a perforator itself without further proximal dissection, and its name according to the perforator type in above principle. (A) Direct cutaneous perforator (DC-p) from its proximal vessel (X). (B) ‘X perforator flap’ based on the DC-p is named from proximal vessel X. (D) Septocutaneous perforator (SC-p) from proximal vessel (Y). (E) ‘Y perforator flap’ based on the SC-p is named from proximal vessel Y. (G) Musculocutaneous perforator (MC-p) variant of the septocutaneous perforator. (H) ‘B perforator flap’ is named from the muscle B perforated by alternative transmuscular course of septocutaneous perforator. (J) Musculocutaneous perforator (MC-p) sprouted from the muscle (C). (K) ‘C perforator flap’ is named from the muscle C perforated. (C), (F), (I) and (L) Perforator ‘based’ flap based on each perforator type. British Journal of Plastic Surgery 2005 58, 431-440DOI: (10.1016/j.bjps.2004.12.009) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 2 Conventional flap and perforator flap in forearm. (A) Forearm fasciocutaneous flap including the deep fascia and septum containing septocutaneous perforator (SCp). MCp, musculocutaneous perforator. (B) Forearm septocutaneous flap excluding the deep fascia. (C) Radial perforator flap based on the SCp with the septum and deep fascia excluded. (D) Flexor carpi radialis (FCR) perforator flap based on MCp sprouting from the FCR muscle. British Journal of Plastic Surgery 2005 58, 431-440DOI: (10.1016/j.bjps.2004.12.009) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 3 Conventional and perforator flap in thigh. LCFA, lateral circumflex femoral artery; Ds, descending branch; VL, vastus lateralis; MCp, musculocutaneous perforator; SCp, septocutaneous perforator. (A) Conventional flap of anterolateral thigh (musculocutaneous) flap can be easily distinguished from perforator flap with its nomenclature. (B) Vastus lateralis perforator flap based on MCp of VL. (C) Descending perforator flap based on SCp without sacrifice of transverse branch and proximal LCFA. (D) Lateral circumflex femoral perforator flap with longer pedicle and proximal branching system for chimeric pattern. (E) Vastus lateralis perforator based flap based on MCp with sparing of proximal descending branch by limited dissection. (F) Descending perforator based flap based on SCp with sparing of descending branch depending on the recipient status. British Journal of Plastic Surgery 2005 58, 431-440DOI: (10.1016/j.bjps.2004.12.009) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 4 Latissimus dorsi perforator based flap. (A) A 29-year-old patient was presented with lymphatic malformation of left lateral thigh. (B) During the radical resection of the skin lesion, the large perforator was found in lateral thigh and was planned for recipient vessels. (C) Postoperative view of flap inset after vascular anastomosis. A 13×7cm latissimus dorsi perforator based flap was harvested with the proximal vessel saved for resurfacing the defect. Long pedicle with large diameter was not necessary for vascular anastomosis on the recipient bed, therefore, perforator pedicle dissection was limited just underneath the latissimus dorsi muscle. (D) Postoperative view after resurfacing. British Journal of Plastic Surgery 2005 58, 431-440DOI: (10.1016/j.bjps.2004.12.009) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions