Chapter 1 and perforator vessels. The European point of view formulated five different perforator vessels and flaps (fig 1.1). Figure 1.1 Schematic drawing of the different types of direct and indirect perfor- ator vessels with regard to their surgical importance. 1, Direct perforators perforate the deep fascia only; 2, indirect muscle perforators predominantly supply the subcutaneous tissues; 3, indirect muscle perforators predominantly supply the muscle but have secondary branches to the subcutaneous tissues; 4, indirect perimysial perforators travel within the perimysium between muscle fibers before piercing the deep fascia; 5, indirect septal perforators travel through the intermuscular septum before piercing the deep fascia. The Canadian proposal was summarized in an article by Geddes et al.19. The nomenclature and abbreviations were very similar to those of the European proposal. The main difference was the differentiation between muscular and septal perforator flaps. Additionally, the abbreviation of the name of the muscle through which the perforator runs was added to the abbreviation of the source vessel. An example was the DIEAP-(ra): deep inferior epigastric artery perforator flap with perforators running through the rectus abdominis muscle. ALTp: anterolateral thigh perforator flap should be LCFAP-vl: lateral circumflex femoral artery perforator flap running through the vastus lateralis muscle. The Asian microsurgical community had the tendency to use more complex terminology to obtain a more specific description of the surgery performed, e.g.: thoracodorsal perforator-based cutaneous island flap instead of TDAP (thoracodorsal artery perforator flap)5. Discussions remain open regarding the nomenclature20. In 2012 Taylor commented that with the advent of modern imaging 11
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