General introduction in the skin and deep tissues was found to correspond in most cases, giving rise to the angiosome concept. Therefore, in short an angiosome is a three-dimensional building block of tissue supplied by a source artery. Over the past 30 years, Taylor has comprehensively documented the vascular anatomy of the human body: he divided the body into 40 angiosomes based on named source arteries, although some of these can be broken down into smaller territories. The “perforator angiosome”, was defined as the territory of supply by a single cutaneous perforator (inter and intra-indivual variability can be very high). Rozen published in 2010 a study about perforator angiosomes of the abdominal wall based on cadaveric study combined with clin ical studies with CTA17a, b. He defined the anatomical territory of a cutaneous perforator by a line drawn through its perimeter of anastomotic vessels that link it with adjacent perforators in all directions: the safe clinical territory of that perforator was found reliably to extend to include the anatomical territory of the next adjacent cutaneous perforator, situated radially in any direction. CLASSIFICATION AND NOMENCLATURE OF PERFORATOR FLAPS Perforator flaps represent the latest descendant in a line of evolution that began with the random flaps. The birth of these new flaps necessitated a more sophisticated definition of a perforator flap and a perforator. One of the most recent definition of the perforator states that a perforator flap is simply a vascularised section of skin and subcutaneous tissue (locoregional or free) that is based on a cutaneous perforator, a vessel that penetrates the outer layer of the deep fascia to reach the skin45. Actually the first surgeon who described a perforator flap was Isao Koshima in 19896. He differentiated perforator flaps from fasciocutaneous flaps, highlighting the inclusion or exclusion of the deep fascia within the flap. During the first years of development of perforator flaps confusion arose about the nomenclature of those flaps: for example the flap based on paraumbilical perforators originating from the deep inferior epigastric artery was called PUP (paraumbilical perforator flap) by Koshima and DIEP (deep inferior epigastric artery) flap by Allen and Treece7. In 2001, during the fifth international course on perforator flaps in Gent, Belgium, a first initiative was taken to simplify the nomenclature of perforator flaps to facilitate communication among surgeons. During the meeting it became clear that there was no clear definition of a perforator flap 10
5. lay-out phd DEFINITIEF_digitaal2
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