Arborization of Musculocutaneous Perforators in the Skin and Subcutaneous Tissue.

Background: The arborization of musculocutaneous (MC) perforators in the skin and subcutaneous tissue has been well studied using cadaver anatomical studies and preoperative imaging such as computed tomography and magnetic resonance angiography. However, the fine arborization of perforators and anastomoses between fine vessels in the skin and subcutaneous tissue remains unreported. Understanding the peripheral arborization and characteristics of these vessels is essential for advancing perforator flap techniques. We performed vascular dissection based on the layered structure to examine the vascular network of the subcutaneous tissue.

Methods: In 8 fresh cadavers, the buttocks (single layer of subcutaneous fat) and back (double layer) were examined through radiological and gross observations of MC perforators, with the fine arterial architecture analyzed in relation to the layered structure of the subcutaneous tissue.

Results: Thin blood vessels at the periphery of the MC perforator were visualized. The perforator reached the dermis, forming a subdermal plexus, from which twigs ascended to the epidermis and descended to the subcutaneous fat. The vascular plexus in subcutaneous tissue varied with the adipofascial structure, and twigs connecting the subdermal plexus to deep adipose tissue were also observed.

Conclusions: The thinning of perforator flaps and the elevation of adipofascial flaps depend on the judgment of clinicians. We believe that understanding the arborization and vasculature of MC perforators will enhance perforator flap procedures, ensuring safer and stable blood flow.