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However, in our method, the flap is based on perforators plexus, taking advantage of the rich blood supply;
without including the muscle. The requirement for perforators can be added to enhance the viability of the
mobilization of the local flap ensures tension-free closure flap. Hence, the flap could be designed with a length: width
of both the donor and recipient sites. ratio in the range of 3:1. The technique is simple, with lower
operating time (approximately 50–60 min), and appears to
The perforator TFL flap was first described by Deiler et al.
[6]
as a free tissue transfer for the reconstruction of Achilles be a reliable flap for coverage of the femoral vessels and
tendon defects. Kimura et al. [7,8] further refined the inguinal region with good tolerance to radiotherapy. As a
microdissection technique and described the emergence single-stage procedure, the superiorly-based perforator plus
[3]
of septocutaneous perforators between the gluteus flap meets the criteria formulated by Gupta et al., with a
[11,12]
medius and TFL muscles. Vegas and Martin-Hervas reliable blood supply and a perforator arterial supply
[9]
described the distribution of the branches to the skin away from the field of resection or radiation. However,
from the perforator between the TFL muscle and the assessment of the aesthetic and functional outcomes of the
gluteus medius and minimus muscles. As a propeller flap, superiorly-based perforator plus flap when compared to
the perforator flap could well be utilized to cover a defect other flaps requires additional investigation.
over the inguinal region. The need for microsurgical Locally advanced genital malignancies, as well as advanced
expertise, the utilization of intramuscular dissection time, stage cutaneous melanomas of the lower extremity, are
the possibility of venous congestion, and the division or common in Asian populations. Radical surgery for the primary
noninclusion of the cutaneous nerve within the flap are and en bloc inguinal or ilio-inguinal lymphadenectomy is
the disadvantages experienced, while performing this often required in such situations. Posttraumatic soft tissue
procedure. The superiorly-based perforator plus flap relies defects in the inguinal region are not uncommon. To reduce
on multiple perforators, without sacrifice of the neural the complications related to wound healing in the groin
component and has a decreased risk of venous congestion region and to withstand postoperative radiotherapy, there
when compared to perforator propeller flaps. is a need for a simple, reliable flap in such patients. The
superiorly-based perforator plus flap can be successfully used
Other flaps utilized in the reconstruction of the soft tissue to reconstruct the inguinal region with reliable coverage of
defect over the inguinal region include the anterolateral the inguinal vessels and early initiation of radiotherapy.
thigh and vertical rectus abdominis muscle flaps. All these
flaps are reliable and provide good soft tissue coverage
but at the expense of the sacrifice of a functioning muscle. REFERENCES

After the advent of the angiosomal concept and perforator 1. Murthy V, Gopinath KS. Reconstruction of groin defects following radical
flaps, skin and subcutaneous tissue-only flaps could be inguinal lymphadenectomy: an evidence based review. Indian J Surg Oncol
elevated in these regions by preserving the perforators 2012;3:130-8.
through the area of the TFL. The vascular anatomy of 2. Swan MC, Furniss D, Cassell OC. Surgical management of metastatic inguinal
lymphadenopathy. BMJ 2004;329:1272-6.
the TFL flap was further studied in detail by Hubmer 3. Gupta AK, Kingsly PM, Jeeth IJ, Dhanraj P. Groin reconstruction after inguinal
et al. The author described the blood supply of the TFL block dissection. Indian J Urol 2006;22:355-9.
[10]
as the ascending branch of the lateral circumflex femoral 4. Wangensteen OH. Repair of recurrent and diffi cult hernias and other large
artery with multiple direct septocutaneous and indirect defects of the abdominal wall employing the iliotibial tract of fascia lata as a
pedicled fl ap. Surg Gynecol Obstet 1934;59:766-80.
musculocutaneous perforators. Clinically, an additional 5. Nahai F, Hill L, Hester TR. Experiences with the tensor fascia lata fl ap. Plast
ultrasound color Doppler is necessary to ensure the Reconstr Surg 1979;63:788-99.
perforator point of the flap, because there is always some 6. Deiler S, Pfadenhauer A, Widmann J, Stützle H, Kanz KG, Stock W. Tensor
vessel variation in this region (4–23%). A perforator flap fasciae latae perforator fl ap for reconstruction of composite achilles tendon
defects with skin and vascularized fascia. Plast Reconstr Surg 2000;106:342-9.
avoiding the TFL muscle will provide all the advantages 7. Kimura N. A microdissected thin tensor fasciae latae perforator fl ap. Plast
of the TFL flap, minimizing the donor site morbidity and Reconstr Surg 2002;109:69-77.
other difficulties arising from the bulkiness of the flap. 8. Kimura N, Saito M, Itoh Y, Sumiya N. Giant combined microdissected thin
thigh perforator fl ap. J Plast Reconstr Aesthet Surg 2006;59:1325-9.
The literature has demonstrated that hyperbaric oxygen 9. Vegas MR, Martin-Hervas C. The superolateral thigh fl ap: cadaver and
therapy enhances oxygen delivery to peripheral tissues computed tomographic angiography studies with a clinical series. Plast Reconstr
affected by vascular disruption, cytogenic and vasogenic Surg 2013;131:310-22.
edema, and cellular hypoxia. Tissue edema significantly 10. Hubmer MG, Schwaiger N, Windisch G, Feigl G, Koch H, Haas FM, Justich I,
Scharnagl E. The vascular anatomy of the tensor fasciae latae perforator fl ap.
affects the perforator flaps, wherein the flaps may Plast Reconstr Surg 2009;124:181-9.
experience venous congestion. In our institution, we 11. Cormack GC, Lamberty GH. The vascular territories and the clinical
include hyperbaric oxygen therapy in our treatment application to the planning of fl aps. In: cormack GC, editor. The Arterial
Anatomy of Skin Flaps. 1 ed. Edinburgh: churchill Livingstone; 1986. p. 318.
st
protocol to reduce postoperative complications related to 12. Pan WR, Taylor GI. The angiosomes of the thigh and buttock. Plast Reconstr
postsurgical inflammatory events. Surg 2009;123:236-49.
In the present study, a superiorly-based perforator plus
flap was used to provide stable soft tissue coverage over How to cite this article: Korambayil PM, Ambookan PV, Dilliraj VK.
the femoral vessels, reducing the risk of wound dehiscence Superiorly based perforator plus fl ap for inguinal defects. Plast Aesthet
and lymphatic drainage problems with minimal donor Res 2014;1:89-93.
site morbidity when compared to other flaps. The flap is Source of Support: Nil, Confl ict of Interest: None declared.
designed as a random pattern flap based on the subdermal Received: 30-06-2014; Accepted: 07-08-2014

Plast Aesthet Res || Vol 1 || Issue 3 || Dec 2014 93