On a hunt for the "true" septocutaneous perforator - a histology cross section study.

Abstract

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 a careful knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications of perforator nomenclature were proposed by many authors and brought confusion rather than a simplification. In our study we focused on a hypothesis, that septocutaneous perforator passes from the given source vessel to the deep fascia adherent to, but not to within the septum itself. 69 septocutaneous perforators from three different limb donor sites (Lateral Arm Flap, Anterolateral Thigh Flap, Radial Forearm Free Flap) were collected from 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 vessel to the septal tissue. Of the observed 69 septal perforators, 61 (88,5%) perforators were adherent to but not within the septum. Remaining eight (12,5%) perforators passed through the septum. All these eight perforators were found in multiple different cross section levels. (two of 19 in Lateral Arm Flap, three of 27 in Anterolateral Thigh Flap, three of 23 in Radial Forearm Free Flap). Although macroscopically identical septocutaneous vessels, microscopically we observe two types of vessels - with paraseptal and intraseptal pathways. The majority are merely adherent to the septum having a paraseptal pathway. 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 any injury of perforator.