Delayed procedure in propeller perforator flap: defining the venous perforasome

The perforasome theory changed our understanding of perforator flaps. Nonetheless, it is a purely arterial perforasome, which corresponds to the area perfused by an arterial perforator. For many perforator flaps, especially the propeller perforator flaps (PPF), skin necrosis develops when there are problems with venous drainage, and can lead to partial distal necrosis. The perforasome theory is not suitable for defining the "venous perforasome". In fact, the venous perforasome is a dynamic process that takes several hours to develop and cannot be analyzed anatomically.

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