Download The angiosomes of the body and their supply to perforator flaps

Clin Plastic Surg 30 (2003) 331 – 342
The angiosomes of the body and their supply to
perforator f laps
G. Ian Taylor, AO, MD, FRACS, FACS
Department of Plastic Surgery, Royal Melbourne Hospital, 7th Floor, 766 Elizabeth Street, Melbourne 3000, Australia
Perhaps one of the most attractive features of
‘‘perforator flaps’’ is that instead of endless descriptions that focus on the tissue components of the flap
or the geometry of various surgical gymnastics to
raise them, often focused on the same vascular
network, we are now revisiting, at last, the most
important factor that determines flap survival, the
anatomy of its blood supply and venous drainage.
By definition, a cutaneous perforator is any vessel
that perforates the outer layer of the deep fascia to
supply the overlying subcutaneous fat and the skin.
These cutaneous perforators, whether arterial or venous, large or small, are derived ultimately from,
or return to, underlying source or segmental vessels
that usually course parallel to the bony skeleton. The
pathway of these cutaneous perforators between the
outer layer of the deep fascia and the source vessels
has given rise to some discussion and different classifications of the blood supply of the skin. These
cutaneous vessels branch from the source artery and
pass either: (1) between the deep tissues to perforate
the outer layer of the deep fascia as fasciocutaneous
(septocutaneous) vessels; or (2) through the deep
tissues, usually as musculocutaneous perforators,
but also arising from vessels that supply other deep
tissues, such as salivary glands, periosteum, and
nerves (Fig. 1).
When we described the angiosome concept [1],
we noted that the source (segmental or distributing)
vessels supplied all tissues between skin and bone as
composite blocks that were linked together by anastomotic arteries. We focused on the origin of the
branches that supplied the various tissues from the
‘‘trunk to the leaves.’’ The surgeons who introduced
the concept of perforator flaps [2 – 4] examined the
same network but in the reverse way, tracing it from
the ‘‘foliage to the roots.’’
Before progressing further, it is important to
review the anatomy of the connective tissue framework of the body; the vessels that ultimately supply the skin, follow this framework, from the aorta
to the dermis. The connective tissue network is a
honeycomb of fibers. It is loose in some areas and
condensed into sheets and septa in others, and surrounds and penetrates the specialized tissues, whether
skin, fat, muscle, tendon or bone, down to the cellular
level. Gray [5] referred to the connective tissues as
‘‘what is left over from the mesoderm during development after the specialized tissues have differentiated.’’ The connective tissue is subdivided into two
compartments (Fig. 2).
The superficial fascia
The superficial fascia is a loose connective tissue
honeycomb that connects the dermis to the outer layer
of the deep fascia and houses the subcutaneous fat,
the breast, and remnants of the panniculus carnosis,
where it still exists (eg, the muscles of facial expression in the head, the platysma in the neck, the
palmaris brevis in the hand, and the dartos muscle
in the scrotum) (see Fig. 2). In some areas, the skin is
fixed firmly to the deep fascia, such as the palms of
the hands and the soles of the feet, by thick perpendicular connective tissue bands. Here, the cutaneous
perforating vessels similarly are short and perpendicular. In other areas, the skin and subcutaneous fat is
mobile over the outer layer of the deep fascia (eg, in
the iliac fossa and over the loins). The vessels are
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G.I. Taylor / Clin Plastic Surg 30 (2003) 331–342
Fig. 1. Diagrammatic cross-sectional view of the blood supply to the skin. Note that the dominant blood supply to the skin passes
between or through the muscles to pierce the outer layer of the deep fascia at fixed skin sites, radiating for long distances where
the skin is mobile. The main anastomoses between adjacent skin perforators is on the surface of the outer layer of the deep
fascia or in the subdermal plexus. (From Taylor GI, Palmer JH. The angiosomes of the body. Br J Plast Surg 1987;40:128;
with permission.)
often large as they perforate the deep fascia at fixed
skin sites and course for long distances oblique or
parallel to the skin surface (see Figs. 1, 2).
The deep fascia
The deep fascia is also a honeycomb of connective tissue. It has a tough outer layer that surrounds
and sometimes provides origin to the muscles, and is
linked by radiating intermuscular septa to the underlying bony skeleton, where it becomes continuous
with the periosteum. It is continued into the muscles
as intramuscular septa. Once again the vessels follow
this connective tissue framework from the source
vessels (which themselves are usually housed in
longitudinal conduits of connective tissue) to pass
either between, or into, the muscles and other deep
tissues (see Fig. 2).
In our dissection and lead oxide injection studies
of fresh cadavers, which led to the angiosome concept, we identified an average of 374 cutaneous
perforators of 0.5 mm or greater (Figs. 3, 4). These
vessels emerged from the deep fascia from fixed skin
sites where they appeared especially:
In longitudinal rows overlying the intermuscular
septa, especially in the limbs
In relation to the fixed attachments of muscles
where the vessels emerged from, or near,
intramuscular septa, especially on the torso
In relation to the fixed attachments of the scalp
and face around the skull base, the parotid gland,
orbits, nose, and lower border of the mandible
Thus, the dominant supply to the skin emerges
from the outer layer of the deep fascia after passing
either between the deep tissues as fasciocutaneous
(septocutaneous) vessels, or through the deep tissues,
usually as musculocutaneous perforators.
From the outer layer of the deep fascia the
cutaneous perforators follow the connective tissue
framework of the superficial fascia toward the skin
with branches that were oriented along a particular
axis (eg, the superficial inferior epigastric artery,
perforators of the internal thoracic stem, or the
occipital vessels), or they radiated in all directions
like the spokes of a wheel (eg, the cutaneous perforators of the arm, forearm, thigh, and leg). In every
case, the perforators connected with their neighbors,
usually by reduced caliber choke arteries, to form a
continuous vascular network, especially in the subdermal plexus beneath the skin. The size, length,
direction, and connections of these cutaneous perforators provide the basis for the viable length of
various skin flap designs, because at least one adjacent anatomical cutaneous vascular territory can be
captured with safety when based on a particular
cutaneous perforator [6 – 9]. In general, the cutaneous
vessels on the torso, head, neck, arms, and thighs are
large and spaced well apart. As this pattern of supply
is traced to the extremities of the hands and the feet,
G.I. Taylor / Clin Plastic Surg 30 (2003) 331–342
333
Fig. 2. Schematic diagram and radiographic study at mid-thigh level of: (A) The connective tissue network of the superficial and
deep fascia. (B) The same network surrounding the specialized tissues of fat in the superficial fascia and the muscles and bone
in the deep compartment. (C) The same as (B), but the vessels have been added that follow the connective tissue framework
of the superficial and deep tissues. (D) Lead oxide cadaver injection to compare with (C). Note the large fasciocutaneous
(septocutaneous) perforators of the femoral and profunda arteries and the large and small musculocutaneous perforators. (See
also Color Plate 1).
the skin vessels become smaller, more numerous, and
closer together (Fig. 5).
When the cutaneous perforators were traced into
the deep tissues toward their source vessels, they
coursed either between the muscles and tendons,
following the intermuscular septa, or penetrated the
muscle to follow the intramuscular septa. In the
former case, the perforators coursed between the deep
tissues, either in loose areola connective tissue (eg,
the cutaneous branches of the radial artery), or they
traveled adjacent to well-defined intermuscular septa
(eg, the cutaneous perforators of the profunda brachii
artery which follow the lateral intermuscular septum
of the arm).
In cases where the perforator emerged from the
muscle by way of an intramuscular septum, it was
traced either straight through the muscle to the
underlying source artery [eg, the cutaneous perforators of the internal thoracic (mammary) artery], or
followed an indirect course parallel to the muscle
fibers, where it was derived from one of the muscle
branches of the source artery (eg, those derived from
the superior gluteal, thoracodorsal, or deep inferior
epigastric arteries).
We subdivided the body anatomically into 40 composite tissue angiosome territories that are supplied
by the various source arteries [1,10]. These angiosomes can be subdivided, in some cases, into
smaller territories. To simplify the concept, we described only one all-embracing intercostal territory
on each side of the torso (see Fig. 4). Obviously, each
of these can be subdivided into the 12 individual
intercostal territories. The same applies to each lumbar angiosome.
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Fig. 3. Schematic diagram of the dominant cutaneous perforators as they emerge from the deep fascia with their underlying
source arteries color-coded to match the angiosomes in Fig. 4. (From Taylor GI, Palmer JH. The angiosomes of the body. Br J
Plast Surg 1987;40:130; with permission.) (See also Color Plate 2).
An overview of the angiosomes, their source
arteries, the sites of origin of the cutaneous perforators and their points of emergence from the outer
layer of the deep fascia are shown (see Figs. 3, 4). To
provide for a better understanding of these angiosomes and their importance in various perforator flap
designs, the territories of the anterior torso are shown
in greater detail (Figs. 6 – 8). Let us examine each of
these in turn.
The internal thoracic (mammary) angiosome
This artery provides the dominant supply to the
skin on the chest with large musculocutaneous per-
forators that are derived from the main artery and
from its anterior intercostal branches, especially those
in relation to the fifth and sixth ribs. To reach the skin
large musculocutaneous perforators pass through the
pectoralis major muscle at its fixed attachment to the
costal cartilages and the ribs. The perforators that
arise from the anterior intercostal arteries in the fourth
and fifth intercostal spaces are the main supply to the
inferior pedicled breast reduction operation.
The internal thoracic artery passes behind the
costal cartilages to enter the anterior abdominal wall,
where it becomes the deep superior epigastric artery
(DSEA). It then enters the back of the rectus abdominis muscle, before reaching the tendonous inter-
G.I. Taylor / Clin Plastic Surg 30 (2003) 331–342
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Fig. 4. The angiosomes of the body color-coded to match Fig. 3. They are: (1) thyroid, (2) facial, (3) buccal (internal maxillary),
(4) ophthalmic, (5) superficial temporal, (6) occipital, (7) deep cervical, (8) transverse cervical, (9) acromiothoracic,
(10) suprascapular, (11) posterior circumflex humeral, (12) circumflex scapular, (13) profunda brachii, (14) brachial, (15) ulnar,
(16) radial, (17) posterior intercostals, (18) lumbar, (19) superior gluteal, (20) inferior gluteal, (21) profunda femoris, (22) popliteal, (22a) descending geniculate (saphenous), (23) sural, (24) peroneal, (25) lateral plantar, (26) anterior tibial, (27) lateral
femoral circumflex, (28) adductor (profunda), (29) medial plantar, (30) posterior tibial, (31) superficial femoral, (32) common
femoral, (33) deep circumflex iliac, (34) deep inferior epigastric, (35) internal thoracic, (36) lateral thoracic, (37) thoraco-dorsal,
(38) posterior interosseous, (39) anterior interosseous, (40) internal pudendal. (From Taylor GI, Palmer JH. The angiosomes of
the body. Br J Plast Surg 1987;40:131; with permission.) (See also Color Plate 3).
section in the muscle that is situated midway between
the costal margin and the umbilicus. The artery subdivides into two or three main branches that subdivide further to form choke connections below,
with branches of the deep inferior epigastric artery
(DIEA) and laterally, with intercostal arteries (see
Figs. 6 – 8).
The cutaneous perforators in the abdomen arise
from the branches of the DSEA, usually just below
the costal margin and in the vicinity of the aforementioned tendonous intersection. To reach the skin, they
pierce the rectus muscle or sometimes pierce the
rectus sheath beside the lateral border of the muscle.
One of these perforators, situated just below the
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cases, it supplies branches to the pectoralis major and
minor muscles and is the dominant supply to the
lateral half of the female breast.
Surgical implications
The lateral thoracic artery has been used as a free
skin flap [11] and as a free skin and breast tissue flap
[12] and is the basis of the lateral pedicled breast
reduction technique of Skoog. [13] The Doppler
probe may help trace the vessel, especially in the
thin patient.
The posterior intercostal angiosomes
Fig. 5. Radiographic lead oxide study of the skin in one of
the fresh cadaver studies. Note how the vessels are large on
the torso, head, neck, arms, and thighs but get smaller and
more dense in the forearms and legs. (From Taylor GI,
Palmer JH. The angiosomes of the body. Br J Plast Surg
1987;40:120; with permission.)
costal margin, is often quite large and is named the
superficial superior epigastric artery.
Surgical implications
If a perforator flap is to be dissected to reach the
internal thoracic-deep superior epigastric source vessels, then in each case the perforator must be traced
through either the pectoralis major muscle and intercostal muscles in the chest or through the rectus
sheath and muscle in the abdomen.
The lateral thoracic angiosome
This artery (see Figs. 6, 7, 8C) may arise from the
axillary artery or its subscapular-thoracodorsal
branch. It is a direct fasciocutaneous vessel that
passes obliquely downward and medially to supply
the skin of the upper lateral chest wall. In 90% of
These intercostal vessels (see. Figs. 6, 7, 8D)
course parallel to the ribs where they groove the
bone, and lie deep to the internal intercostal muscles.
In the chest, they anastomose, often without change
in caliber, with the anterior intercostal branches of the
internal thoracic artery. In the abdomen, they leave
the rib cage and enter the anterior abdominal wall
between the transversus abdominis and internal
oblique muscles where they anastomose with lateral
branches of the DSEA and the DIEA.
Their musculocutaneous branches pass through
the fixed attachments of muscles. In the mid-axillary
line they emerge from the outer layer of the deep
fascia as a vertical strip of vessels. This occurs where
the external oblique muscle interdigitates with the
serratus anterior in the chest and where it interlocks
with the latissimus dorsi in the lower lateral abdominal wall. Further anteriorly, some cutaneous vessels pierce the internal oblique and the external
oblique muscles to reach the skin.
Surgical implications
These musculocutaneous perforators may be quite
large; if a perforator skin flap is to be designed,
dissection must proceed through several muscles
before reaching the intercostal source vessels. The
Doppler probe is a useful aid to locate these perforators on the skin surface, especially in a thin, wellmuscled individual.
The deep inferior epigastric angiosome
Currently, this source vessel (see Figs. 6, 7, 8E)
provides the most popular musculocutaneous perforator flap. It has been described in detail elsewhere
[14 – 17]. The DIEA arises from the terminal portion of the external iliac artery, just above the
inguinal ligament. It ascends upward and medially,
passing behind the rectus muscle where it travels
on its deep surface for a variable distance before
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337
Fig. 6. Radiographic lead oxide study of the anterior torso without skin showing the source vessels and their branches. One side
is color-coded to match the angiosomes in Fig. 4. Lines have been drawn through the choke anastomotic vessels that define the
boundaries of the adjacent angiosomes From top to bottom they are acromiothoracic, lateral thoracic, internal thoracic, posterior
intercostal, lumbar, deep circumflex iliac, deep inferior epigastric, and common femoral. The umbilicus is highlighted as an
ellipse and lead beads (shown on the left side) show the site of origin of the cutaneous perforators from the source vessels. (See
also Color Plate 4).
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Fig. 7. Radiographic lead oxide study of the skin of the anterior torso in the same subject that is shown in Fig. 6, including the
shoulders and proximal thighs. The cutaneous perforators are color-coded to match the angiosomes in Fig. 6 with the emergence
of large perforators that are highlighted as dots on the left side. In addition to Fig 6, portions of the angiosomes of the transverse
cervical and inferior thyroid have been included at the top of the figure. Note the choke anastomotic connections that link
adjacent cutaneous perforators. (See also Color Plate 5).
G.I. Taylor / Clin Plastic Surg 30 (2003) 331–342
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Fig. 8. Schematic diagram of the source vessels and dominant cutaneous perforators of the (A) anterior torso, (B) internal
thoracic, (C) lateral thoracic, (D) posterior intercostals, (E) deep inferior epigastric, and ( F) deep circumflex iliac angiosomes
that are color-coded to match Figs. 3, 4, 6, and 7. (See also Color Plate 6).
entering the muscle. The DIEA provides a recurrent
branch that returns toward the pubis (see Fig. 6)
and may ascend as: (1) a single vessel with ‘‘herringbone’’ branches (29%); (2) two main branches,
medial and lateral, (57%); or, (3) multiple branches
(14%) [14]. Regardless of the pattern, these
branches anastomose, usually by reduced caliber
vessels, with branches of the DSEA within the
rectus muscle above the umbilicus. Branches also
radiate laterally and pierce the rectus sheath to lie
in company with the incoming intercostal nerves
between the internal oblique and transversus abdominis aponeuroses and anastomose with the posterior intercostal arteries.
Two types of vessels are provided to the overlying skin. Medially, musculocutaneous perforators
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pierce the anterior rectus sheath over the muscle in
line with the main branches of the DIEA or its
subdivisions. Laterally, fasciocutaneous perforators
pierce the aponeuroses of the internal and external
oblique muscles to emerge along the lateral border of
the rectus muscle. A large fasciocutaneous perforator
is seen on each side of the abdomen (see Fig. 6). The
largest number of sizeable perforators are clustered
within 3 cm of the umbilicus [14].
Surgical implications
Many designs of vertical, transverse, or oblique
skin flaps are available that may incorporate one or
several perforators. In most cases, one or two musculocutaneous perforators are included along the axis
of the DIEA branches. Care must be taken to
preserve as many intercostal nerves as possible,
however, because they pass anteriorly (superficial)
to the DIEA branches.
Fig. 9. Arterial injection radiographic study of the latissimus dorsi muscle with thoracodorsal, posterior intercostal, and lumbar
angiosome territories defined. The sites of large musculocutaneous perforators are highlighted. A large arrow identifies one
perforator that arises from the posterior intercostal artery but which could also be traced by way of it large anastomotic branch to
the thoraco-dorsal system (small arrows). (See also Color Plate 7).
G.I. Taylor / Clin Plastic Surg 30 (2003) 331–342
341
The deep circumflex iliac angiosome
The latissimus dorsi muscle
Arising from the external iliac artery, this vessel
(see Figs. 6, 7, 8F) courses laterally, parallel to the
inguinal ligament and deep to all muscles of the
abdominal wall, to reach the inner surface of the wing
of the ileum in the groove between the transversus
abdominis and the iliacus muscles. It provides a large
ascending branch that pierces the transversus muscle
medial to the anterior superior iliac spine (ASIS) after
which it ascends the abdominal wall between the
transversus abdominis and internal oblique muscles.
The deep circumflex iliac artery (DCIA) provides a
significant cutaneous perforator in only 10% of cases
[18]. The main DCIA trunk, however, pierces all three
muscles of the lateral abdominal wall, approximately
6 cm to 8cm beyond the ASIS, to provide a sizeable
musculocutaneous perforator.
Many large cutaneous vessels emerge as musculocutaneous perforators from the superficial surface
of the latissimus dorsi muscle. There are a few traps
for the unwary, however. Close inspection of Fig. 9
reveals that the muscle traverses three angiosomes, an
upper thoracodorsal, middle intercostal, and lower
lumbar. In the last two territories, the muscle is fixed
to the rib cage and the lumbar fascia. Here, the
musculocutaneous perforators are derived from intercostal or lumbar arteries and perforate the latissimus
muscle vertically to reach the skin.
In the thoracodorsal territory, however, where
the muscle is mobile, the musculocutaneous perforators arise from branches of the thoracodorsal artery
as they course parallel to the muscle fibers and the
skin surface.
In some sites, the cutaneous perforator can be
traced in either of two directions, vertically to reach
the underlying intercostal stem, or horizontally along
the muscle fibers by way of the anastomotic connection (which is usually a true anastomosis) with a
branch of the thoracodorsal artery to provide a lone
pedicle (see arrows in Fig. 9).
Surgical implications
DCIA has been used to provide a musculocutaneous flap for lower limb reconstruction [19]
and as the so-called ‘‘Ruben’s flap’’ [20] for breast
reconstruction. In each case, however, a segment of
muscle was included to incorporate several musculocutaneous perforators, although, in theory, a pure
musculocutaneous perforator flap could have been
raised (but not without some technical difficulty).
The superficial inferior epigastric angiosome
This direct fasciocutaneous perforator, the superficial inferior epigastric artery (SIEA) (see Figs. 7,
8A), provided the basis for the first reported free flap
[21,22]. It arises from the common femoral artery
either alone, or in combination with, the superficial
circumflex iliac artery [23], pierces the deep fascia
below the inguinal ligament, and ascends the abdominal wall for a variable distance. In some cases, it may
reach as high as the level of the umbilicus. The SIEA
anastomoses with branches of the superficial circumflex iliac artery (SCIA), intercostal perforators, DIEA
perforators, and its fellow of the opposite side.
Surgical implications
The SIEA can be identified and traced for a considerable distance with the Doppler probe in a thin
individual. Its territory is quite large and it has been
used extensively as a pedicled flap for hand reconstruction [24]. The SIEA also has been used as a
fasciocutaneous perforator free flap for breast reconstruction with the skin paddle designed transversely in the lower abdomen [25,26].
Discussion
It is apparent from the above examples that, with
some exceptions, most perforator flaps on the torso
will involve an intramuscular dissection to reach the
underlying source vessel of the angiosome. In the
limbs, the reverse usually is the case. A cross-section
of the thigh where the dominant supply to the skin
passes between the muscles in most cases is shown
(see Fig. 2). Nevertheless, a large musculocutaneous
perforator is seen arising from the lateral circumflex
femoral artery in this study.
Any attempt to classify either the blood supply to
the skin or the various types of ‘‘perforator flaps’’ was
intentionally avoided because this issue is still in a
state of flux. Whatever the outcome, it is important to
make the distinction as simple as possible. From the
practical point of view, it is important to know which
source vessel is giving origin to the perforator and
whether the perforator will be isolated with its skin
paddle by a dissection either between tissues (usually
muscle, but they could be tendon or bone) or through
the tissues (usually muscle). Thus, most perforator
flaps would ultimately be supplied by either fasciocutaneous (septocutaneous) or musculocutaneous vessels. In some cases, usually in the first group, the skin
perforator will be accompanied by a cutaneous nerve.
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It is pleasing that perforator flaps have refocused
our attention on the fundamental basis of all good
surgery, the applied anatomy of the region.
References
[1] Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987;40:113 – 41.
[2] Allen RJ, Treece P. Deep inferior epigastric flap for
breast reconstruction. Ann Plast Surg 1994;32:32.
[3] Blondeel PN, Boeckx WD. Refinements in free flap
breast reconstruction: the free bilateral deep inferior
epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg 1994;47(7):
495 – 501.
[4] Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg
1999;52(2):104 – 11.
[5] Johnston TB, Davies DV, Davies F, editors. Gray’s
anatomy. 32nd edition. London: Longmans, Green &
Co.; 1958.
[6] Callegari PR, Taylor GI, Caddy CM, et al. An anatomic review of the delay phenomenon: I experiment
studies. Plast Reconstr Surg 1992;89:397.
[7] Dhar S, Taylor GI. The delay phenomenon: the story
unfolds. Plast Reconstr Surg 1999;104(7):2079 – 91.
[8] Morris SF, Taylor GI. Predicting the survival of experimental skin flaps based on a knowledge of the vascular
architecture. Plast Reconstr Surg 1993;92:1352 – 71.
[9] Taylor GI, Corlett RJ, Caddy CM, et al. An anatomic
review of the delay phenomenon: II clinical applications. Plast Reconstr Surg 1992;89:402.
[10] Taylor GI. The blood supply of the skin. In: Aston SJ,
Beasley RW, Thorne CHM, editors. Grabb & Smith’s
plastic surgery. 5th edition. Philadelphia: LippincottRaven Publishers; 1997. p. 47 – 59.
[11] Baudet J, Guimberteau JC, Nascimento E. Successful
clinical transfer of two free thoraco-dorsal axillary
flaps. Plast Reconstr Surg 1976;58(6):680 – 8.
[12] Le Quang C. Free transfer of contralateral breast tissue for breast reconstruction. Presented at the 5th International Society of Reconstructive Microsurgery
Meeting. Guaraja, Brazil, May 15 – 18, 1979.
[13] Skoog T. A technique of breast reduction. Transposition of the nipple on a cutaneous vascular pedicle. Acta
Chir Scand 1963;126:453.
[14] Boyd JB, Taylor GI, Corlett RJ. The vascular territory
of the superior epigastric and the deep inferior epigastric arteries. Plast Reconst Surg 1984;73:1.
[15] Moon HJ, Taylor GI. The vascular anatomy of rectus
abdominis musculocutaneous flaps based on the deep
superior epigastric system. Plast Reconstr Surg 1988;
82:815.
[16] Taylor GI, Watterson PA, Zelt RG. The vascular anatomy of the anterior abdominal wall: the basis of flap
design. Perspectiv Plast Surg 1991;5:1.
[17] Taylor GI. Discussion. The vascular anatomy of the
lower anterior abdominal wall. A micro dissection
study on the deep inferior epigastric vessels and the
perforator branches by El-Mrakby HH, Milner RH.
Plast Reconstr Surg 2002;109(2):544 – 7.
[18] Taylor GI, Townsend PLG, Corlett RJ. Superiority of
the deep circumflex iliac vessels as the supply for free
groin flaps - experimental work. Plast Reconstr Surg
1979;64:595.
[19] Taylor GI, Townsend PLG, Corlett RJ. Superiority of
the deep circumflex iliac vessels as the supply for free
groin flaps - clinical work. Plast Reconstr Surg 1979;
64:745.
[20] Hartrampf Jr CR, Noel RT, Drazan L, et al. Ruben’s fat
pad for breast reconstruction: a peri-iliac soft-tissue
free flap. Plast Reconstr Surg 1994;93(2):402 – 7.
[21] Daniel RK, Taylor GI. Distant transfer of an island flap
by microvascular anastomosis. Plast Reconstr Surg
1973;52:111.
[22] Taylor GI, Daniel RK. The free flap. ANZ J Surg 1973;
43:1.
[23] Taylor GI, Daniel RK. The anatomy of several free flap
donor sites. Plast Reconstr Surg 1975;56:243.
[24] McGregor IA, Jackson IT. The groin flap in hand injuries. Br J Plast Surg 1973;4(3):229 – 39.
[25] Hester Jr TR, Nahai F, Beegle PE, et al. Blood supply of the abdomen revisited, with emphasis on the
superficial inferior epigastric artery. Plast Reconstr
Surg 1984;74(5):657 – 70.
[26] Taylor GI. Discussion. Blood supply of the abdomen
revisited, with emphasis on the superficial inferior epigastric artery, by Hester TR, Nahai F, Beegle PE, et al.
Plast Reconstr Surg 1984;74:667.