Annals of Plastic Surgery • Volume 74, Number 6, June 2015
Letter to the Editor
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flaps according to their vascularization. Ann Plast Surg. 1986;16:1–19. Vandevoort M, Vranckx JJ, Fabre G. Perforator topography of the deep inferior epigastric perforator flap in 100 cases of breast reconstruction. Plast Reconstr Surg. 2002;109:1912–1918. Chen CM, Allen RJ. Breast reconstruction with the septocutaneous perforator flap: the next frontier. Plast Reconstr Surg. 2009;124(Suppl 2):S680. Massey MF, Spiegel AJ, Levine JL, et al. for the Group for the Advancement of Breast Reconstruction. Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions. Plast Reconstr Surg. 2009;124:737–751. Blondeel PN, Van Landuyt KHI, Monstrey SJM, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003;112:1378–1382. Woodburne RT. Editor, Essentials of Human Anatomy. 4th ed. New York: Oxford University Press, New York; 1969:15–17. Woodburne RT. Editor, Essentials of Human Anatomy. 4th ed. New York: Oxford University Press, New York; 1969:366. Woodburne RT. Editor, Essentials of Human Anatomy. 4th ed. New York: Oxford University Press, New York; 1969:11. Neligan PC, Blondeel PN, Morris SF, et al. Perforator Flaps: Overview, Classification, and Nomenclature. In: Blondeel PN, Morris SF, Hallock GG, Neligan PC, eds. Perforator Flaps: Anatomy, Technique, & Clinical Applications. Second ed. St. Louis, Missouri: Quality Medical Publishing; 2013: 59–60. Gravvanis A, Dionyssiou DD, Chandrasekharan L, et al. Paramuscular and paraneural perforators in DIEAP flaps: radiographic findings and clinical application. Ann Plast Surg. 2009;63:610–615.
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Paramuscular Perforators in Dieap Flap for Breast Reconstruction An Important Variation in Perforator Flap Nomenclature: Reply
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e thank Dr Hallock both for the exquisite anatomical description and accurate discussion about paramuscular perforators, as well as clarifying a very important point which we have also tried to illustrate in our article.1 We agree that paramuscular perforators meet all the criteria that enable them to be considered as a “direct cutaneous branch of muscular vessel” in keeping with Nakajima's definition.2 There is no doubt, according to the strict anatomical description highlighted by Dr Hallock, that these perforators cannot be defined as paraseptal, given that the sheath surrounding
the rectus abdominis muscle is in fact formed by aponeuroses and not a real septum. Although in our article, we have attempted to categorize these paramuscular perforators within the terminology consensus set in Gent,3 we acknowledge our error in considering these perforators as paraseptal. Indeed, as pointed out by Dr Hallock, the morphological features and particular course of paramuscular perforators clearly differentiate them from muscular and septocutaneous perforators and make them worthy of their own nomenclature.
Gemma Pons, MD Department of Plastic and Reconstructive Surgery Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona, Spain [email protected].
REFERENCES Received February 13, 2015, and accepted for publication, after revision, March 16, 2015. Conflicts of interest and sources of funding: none declared. Reprints: Gemma Pons, MD, Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autòmoma de Barcelona, Sant Quintí 89, 08041 Barcelona, Spain. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/15/7406-0746 DOI: 10.1097/SAP.0000000000000536
1. Pons G, Masia J, Sanchez-Porro L, et al. Paramuscular perforators in DIEAP flap for breast reconstruction. Ann Plast Surg. 2014;73:659–661. 2. Nakajima H, Fujino T, Adachi S. A new concept of vascular supply to the skin and classification of skin flaps according to their vascularization. Ann Plast Surg. 1986;16:1–19. 3. Blondeel PN, Van Landuyt KHI, Monstrey SJM, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003;112:1378–1382.
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Letter to the Editor
3.
4.
5.
6.
7.
8.
9.
10.
11.
flaps according to their vascularization. Ann Plast Surg. 1986;16:1–19. Vandevoort M, Vranckx JJ, Fabre G. Perforator topography of the deep inferior epigastric perforator flap in 100 cases of breast reconstruction. Plast Reconstr Surg. 2002;109:1912–1918. Chen CM, Allen RJ. Breast reconstruction with the septocutaneous perforator flap: the next frontier. Plast Reconstr Surg. 2009;124(Suppl 2):S680. Massey MF, Spiegel AJ, Levine JL, et al. for the Group for the Advancement of Breast Reconstruction. Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions. Plast Reconstr Surg. 2009;124:737–751. Blondeel PN, Van Landuyt KHI, Monstrey SJM, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003;112:1378–1382. Woodburne RT. Editor, Essentials of Human Anatomy. 4th ed. New York: Oxford University Press, New York; 1969:15–17. Woodburne RT. Editor, Essentials of Human Anatomy. 4th ed. New York: Oxford University Press, New York; 1969:366. Woodburne RT. Editor, Essentials of Human Anatomy. 4th ed. New York: Oxford University Press, New York; 1969:11. Neligan PC, Blondeel PN, Morris SF, et al. Perforator Flaps: Overview, Classification, and Nomenclature. In: Blondeel PN, Morris SF, Hallock GG, Neligan PC, eds. Perforator Flaps: Anatomy, Technique, & Clinical Applications. Second ed. St. Louis, Missouri: Quality Medical Publishing; 2013: 59–60. Gravvanis A, Dionyssiou DD, Chandrasekharan L, et al. Paramuscular and paraneural perforators in DIEAP flaps: radiographic findings and clinical application. Ann Plast Surg. 2009;63:610–615.
746
www.annalsplasticsurgery.com
Paramuscular Perforators in Dieap Flap for Breast Reconstruction An Important Variation in Perforator Flap Nomenclature: Reply
W
e thank Dr Hallock both for the exquisite anatomical description and accurate discussion about paramuscular perforators, as well as clarifying a very important point which we have also tried to illustrate in our article.1 We agree that paramuscular perforators meet all the criteria that enable them to be considered as a “direct cutaneous branch of muscular vessel” in keeping with Nakajima's definition.2 There is no doubt, according to the strict anatomical description highlighted by Dr Hallock, that these perforators cannot be defined as paraseptal, given that the sheath surrounding
the rectus abdominis muscle is in fact formed by aponeuroses and not a real septum. Although in our article, we have attempted to categorize these paramuscular perforators within the terminology consensus set in Gent,3 we acknowledge our error in considering these perforators as paraseptal. Indeed, as pointed out by Dr Hallock, the morphological features and particular course of paramuscular perforators clearly differentiate them from muscular and septocutaneous perforators and make them worthy of their own nomenclature.
Gemma Pons, MD Department of Plastic and Reconstructive Surgery Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona, Spain [email protected].
REFERENCES Received February 13, 2015, and accepted for publication, after revision, March 16, 2015. Conflicts of interest and sources of funding: none declared. Reprints: Gemma Pons, MD, Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autòmoma de Barcelona, Sant Quintí 89, 08041 Barcelona, Spain. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/15/7406-0746 DOI: 10.1097/SAP.0000000000000536
1. Pons G, Masia J, Sanchez-Porro L, et al. Paramuscular perforators in DIEAP flap for breast reconstruction. Ann Plast Surg. 2014;73:659–661. 2. Nakajima H, Fujino T, Adachi S. A new concept of vascular supply to the skin and classification of skin flaps according to their vascularization. Ann Plast Surg. 1986;16:1–19. 3. Blondeel PN, Van Landuyt KHI, Monstrey SJM, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003;112:1378–1382.
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
