In reconstructive surgery, perforator flaps have a short history. Not more than 27 years ago, Nakajima et al. described the six types of perforator vessels known at present: direct cutaneous, direct septocutaneous, direct cutaneous branch of muscular vessel, perforating cutaneous branch of muscular vessel, septocutaneous perforator and musculo-cutaneous perforator . (Fig. 1)
The knowledge about these perforator vessels continuously grew, by identifying the vascular networks of the entire body, formed by the perforator vessels. Therefore, it became possible to create a lot of perforator flaps based on these perforator vessels . Thus, perforator flaps can be considered the latest milestone in the evolution of reconstructive flap surgery. Many methods are used for investigating the exact location of the perforators, such as imaging methods: computed tomography, magnetic resonance angiography and lately thermal imaging that became also reliable . The exact knowledge of the location and caliber of perforators became a real help for plastic surgeons, especially in the calf area, where the reconstructive method has to accomplish the functional and aesthetic needs for both reconstructed and donor areas.