Confusion of perforator flap concept has been somewhat caused by perplexed usage of its nomenclature without consistency such as DIEP flap according to the proximal vessel and anterolateral thigh perforator flap according to the region. Such an inconsistency has resulted confusion of definition on the true perforator and finally various nomenclatures have been overused in the articles newly published. Flap nomenclatures named as one likes can disturb the exact understanding of the flap itself and its perforator used and therefore, exact and scientific concept of perforator flap nomenclature is requisite.

54 articles and 38 abstracts were reviewed in the aspect of nomenclature. Vague and inaccurate expressions were searched and conventional flaps were compared with the perforator flaps from the point that the nomenclature could actually represent the character of the flap and distinguish each other.

New nomenclature is categorized according to the perforator types such as direct cutaneous(DCp), septocutaneous(SCp) and musculocutaneous perforator(MCp). As the last one MCp is a real perforator that pierces from the muscle, it is thought to be fair to discriminate it from the former two types under the different nomenclature. So in new nomenclature system, perforator flap based on the MCp is named according to the name of muscle perforated and, perforator flaps based on other perforator patterns named according to the name of proximal vessel. The nomenclature of “perforator-based” flap is recommended to use for the flap harvested without sacrifice of the proximal vessel like it means. As most perforator flaps from back or extremities are proved to have a common superiority of thin character, impertinent expressions of “superthin”, “ultrathin”, and “microthin” are necessary to be unified into a proper one as “thin”.

This new nomenclature concept is great help to discriminate the perforator flap from other conventional flaps and to prevent forthcoming confusion by new perforator flaps that will be introduced. The perforator pattern used in the flap are easily comprehended and the dissection course are readily predicted when the flap name is heard or read, especially in perforator flaps of extremity.

Fig. 1. Perforator flap based on DCp ; X perforator flap named according to proximal vessel “X”.

Fig. 2. Perforator flap based on SCp ; Y perforator flap named according to proximal vessel “Y”.

Fig. 3. Perforator flap based on MCp ; C perforator flap named according to the muscle “C” perforated instead of proximal vessel “Z”.