Useful Flaps for Plastic Surgeons to Know | Journal CME Article-Journal CME Article: Useful Flaps for Plastic Surgeons to Know (Video 3)

Video Transcription

This video clip shows the importance of determining whether your perforator is going to carry your flap. This is a superficial ALT flap that has been dissected.  We have identified two perforators, one distally and one more or less in the middle of the flap. Here you can see me dividing the fascia between the two perforators.  Now I need to know whether I need both perforators or whether I can get away with harvesting just on one, which would make it far more simple.  The way I am going to do that is to place a clamp on the distal perforator and inject indocyanin green.  Here you can see the clamp on the left side of your screen on the distal perforator. You can see that that part of the flap is not perfusing.  The proximal part of the flap is perfusing. My resident is on the right-hand side. You will see him turn around and remove that clamp.  As he does so, you will see that the rest of the flap perfuses very nicely. Now the whole flap is perfusing and this is telling me that I need both perforators.  This is really important.

Video Summary

The video emphasizes the importance of determining if your perforator will support a flap. In a superficial ALT flap dissection, two perforators are identified. To simplify the procedure, the surgeon experiments to see if both perforators are needed by clamping the distal one and injecting indocyanin green. The lack of perfusion in the flap's distal part indicated the necessity of both perforators. Once the clamp is removed, perfusion improves, confirming the need for both perforators to ensure full flap viability. This step is critical for successful flap reconstruction.

Keywords

perforator

ALT flap

indocyanin green

flap reconstruction

perfusion