Three types of perforators such as direct cutaneous(DCp), septocutaneous(SCp) and musculocutaneous perforator(MCp) can be found in flank area. Of them, MCp has been popularly used as a pedicle and the flap can be named according to the muscle name perforated such as latissimus dorsi perforator(LDP) flap. As another row of SCp can also be found between serratus anterior and latissimus dorsi muscles, the flap based on it is named according to the proximal vessel such as thoracodorsal perforator(TDP) flap. These varieties of perforator flap selection can make it possible to obtain the perforator flap in flank area with more reliability.

In LDP flap, the size of the flap ranged from 5 x 3cm to 20 x 15cm (300cm²). After vascular anastomosis, marginal necrosis was occurred in two cases including an extremely large flap of 26 x 12cm. The TDP flap based on the SCp was utilized in 13 cases including the 2 cases of chimeric composition and the flap size ranged 4.5 x 3.5 to 18 x 15cm without any serious complication. Perforator flap with small portion of muscle was utilized in 6 cases in which unduly large or improperly long flap was planned. The flap size ranged 22 x 7 to 15 x 28cm (420cm²) and a partial necrosis of the distal portion of the flap occurred in one case using 34 x 10cm. Larger dimension of flap with small portion of muscle, less than 3 x 3cm, is available than pure perforator flap when inordinately long flap is necessary or the reliable perforator is difficult or too tiny to detect.

Diverse selection of perforator flap from flank area is one of great advantages of this area. With the incision anterior to the muscle border, TDP flap based on the SCp can be challenged in advance, and then LDP flap based on the MCp flap is considered by comparing the reliability of two perforators. As both perforator flaps are nearly the same in the aspect of reliability, various patterns of perforator flaps can be designed depending on perforator pattern and the original surgical plan can be modified for successful flap harvest. And therefore, more options can be opened to the microsurgeon to select the perforator flap in the flank area and flank area is a good donor site for perforator flap reconstruction.

Fig. 1. Latissimus dorsi perforator flap.

Fig. 2. Thoracodorsal perforator flap.