Concept and anatomical basis of microdissected tailoring method for free flap transfer.

Background: For a refined microsurgical reconstruction, it is desirable to adjust the flap to fit the three-dimensional details of the defect. Essentially, each vessel arborized in the subcutaneous adipose tissue supplies axial blood flow to an individual small area surrounding the vessel. Therefore, free alteration of the flap would be possible if the anatomy of these branches could be identified during surgery.

Methods: The microdissected tailoring method is a new procedure for alteration of the flap, observing the branches of the perforator directly after microdissection. By means of this procedure, three flaps were transferred to complex tissue defects. In addition, among intraadipose branches of 59 perforators, 90 cases of three types of microdissected thin perforator flap transfer were measured to classify the anatomical variations relating to microdissected tailoring of the flap.

Results: All flap transfers were uneventful and no circulatory failure of the flaps was observed. Statistical analyses reveal that the intermuscular septum perforator branches at the deeper layer of the adipose tissue and then spreads more widely in the adipose layer than that of muscle perforator, regardless of the type of flap and the length of the intraadipose vessel.

Conclusions: Microdissected tailoring of the flap provides the best solution for flap alteration in the reconstruction of a complex-shaped tissue defect. It represents a change in the concept of free flap transfer, because the flap is prepared according to the individual anatomy of the intraadipose vessel.