Understanding Vascular Anatomy of the Lower Limb to Help the Planning of Perforator Based Island Flaps

In this chapter I will try to simplify vascular anatomy for the cutaneous surgeon and offer insights into the locations of perforator clusters to help in the planning of island flaps. Studies on vascular anatomy have confirmed that the vascular plane on the lower limb lies deep to the deep fascia. Yet, many flaps are routinely raised superficial to this plane and therefore flap failure rates in the lower limb are high. Fascio-cutaneous flaps based on perforators offer a better cosmetic alternative to skin grafts. In this study, a thermal imaging camera is used to identify perforator ‘compartments’ that can help in designing such perforator-based flaps.