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# Rat Perforator and Skin Vessels Vascular Mapping: An Original Anatomical Study About 140 Vessels and Literature Review

Ugo Lancien, Baptiste Charbonnier, Pierre Weiss, Pierre Corre, Pierre Perrot

► To cite this version:

Ugo Lancien, Baptiste Charbonnier, Pierre Weiss, Pierre Corre, Pierre Perrot. Rat Perforator and Skin Vessels Vascular Mapping: An Original Anatomical Study About 140 Vessels and Literature Review. Journal of Surgical Research, 2023, pp.298-308. 10.1016/j.jss.2023.03.015. hal-04600522

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Submitted on 4 Jun 2024

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Distributed under a Creative Commons Attribution 4.0 International License
Rat perforator and skin vessels vascular mapping: an original anatomical study about
140 vessels and literature review.

U.Lancien (1) (2) (4), B.Charbonnier (2) (4), P.Weiss (2) (4), P.Corre (2) (3) (4), P.Perrot
(1) (2) (4)

(1) Plastic, Reconstructive, and Aesthetic Surgery Unit

Nantes University Hospital, 1 place Alexis Ricordeau, 44000 NANTES, FRANCE.

(2) INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), 1
place Alexis Ricordeau, 44000 NANTES, FRANCE.

(3) Maxillofacial surgery unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 NANTES, FRANCE.

(4) Université de Nantes, UFR Odontologie, 1 place Alexis Ricordeau, 44000 NANTES, FRANCE.

Corresponding author:

Ugo Lancien

Plastic, Reconstructive, and Aesthetic Surgery Unit

Nantes University Hospital

1 place Alexis Ricordeau 44000 NANTES, FRANCE

ulancien@gmail.com

Keywords

Rat perforator mapping; Microsurgery; anatomical study
Rat perforator and skin vessels vascular mapping: an original anatomical study about
140 vessels and literature review.

U.Lancien (1) (2) (4), B.Charbonnier (2) (4), P.Weiss (2) (4), P.Corre (2) (3) (4), P.Perrot
(1) (2) (4)

(1) Plastic, Reconstructive, and Aesthetic Surgery Unit

Nantes University Hospital, 1 place Alexis Ricordeau, 44000 NANTES, FRANCE.

(2) INSERM, UMRS 1229, Laboratory Regenerative Medicine and Skeleton (RMeS), 1
place Alexis Ricordeau, 44000 NANTES, FRANCE.

(3) Maxillofacial surgery unit, Nantes University Hospital, 1 place Alexis Ricordeau, 44000 NANTES, FRANCE.

(4) Université de Nantes, UFR Odontologie, 1 place Alexis Ricordeau, 44000 NANTES, FRANCE.

Corresponding author:

Ugo Lancien

Plastic, Reconstructive, and Aesthetic Surgery Unit

Nantes University Hospital

1 place Alexis Ricordeau 44000 NANTES, FRANCE

ulancien@gmail.com

Keywords

Rat perforator mapping; Microsurgery; anatomical study
**Abstract**

**Background**

Recent microsurgical reconstruction techniques benefit from the use of skin and perforator flaps that spare the donor sites. Studies on these skin flaps in rat models are numerous but there is currently no reference regarding the position of the perforators, their caliber, and the length of the vascular pedicles.

**Methods**

We performed an anatomical study on 10 Wistar rats and 140 vessels: cranial epigastric (CE), superficial inferior epigastric (SIE), lateral thoracic (LT), posterior thigh (PT), deep iliac circumflex (DCI) and posterior intercostal (PIC) vessels. The evaluation criteria were the external caliber, the length of the pedicle, and the position of the vessels reported on the skin surface.

**Results**

Data from the six perforator vascular pedicles are reported, with figures illustrating the orthonormal reference frame, the representation of the vessel's position, the cloud of points corresponding to the various measurements, and the average representation of the collected data.

The analysis of the literature does not find similar studies; the different vascular pedicles are discussed as well as the limitations of our study: evaluation of cadaver specimen, presence of the very mobile panniculus carnosus, other perforator vessels not evaluated as well as the precise definition of perforating vessels.

**Conclusion**
**Abstract**

**Background**

Recent microsurgical reconstruction techniques benefit from the use of skin and perforator flaps that spare the donor sites. Studies on these skin flaps in rat models are numerous but there is currently no reference regarding the position of the perforators, their caliber, and the length of the vascular pedicles.

**Methods**

We performed an anatomical study on 10 Wistar rats and 140 vessels: cranial epigastric (CE), superficial inferior epigastric (SIE), lateral thoracic (LT), posterior thigh (PT), deep iliac circumflex (DCI) and posterior intercostal (PIC) vessels. The evaluation criteria were the external caliber, the length of the pedicle, and the position of the vessels reported on the skin surface.

**Results**

Data from the six perforator vascular pedicles are reported, with figures illustrating the orthonormal reference frame, the representation of the vessel's position, the cloud of points corresponding to the various measurements, and the average representation of the collected data.

The analysis of the literature does not find similar studies; the different vascular pedicles are discussed as well as the limitations of our study: evaluation of cadaver specimen, presence of the very mobile panniculus carnosus, other perforator vessels not evaluated as well as the precise definition of perforating vessels.

**Conclusion**
Our work describes the vascular calibers, pedicle lengths, and location of birth and arrival at the skin of the perforator vessels PT, DCI, PIC, LT, SIE, and CE in rat animal models. This work, without an equivalent in the literature, lays the foundation for future studies about flap perfusion, microsurgery, and super microsurgery learning.

Keywords

Rat perforator mapping; Microsurgery; anatomical study
Our work describes the vascular calibers, pedicle lengths, and location of birth and arrival at the skin of the perforator vessels PT, DCI, PIC, LT, SIE, and CE in rat animal models. This work, without an equivalent in the literature, lays the foundation for future studies about flap perfusion, microsurgery, and super microsurgery learning.

Keywords

Rat perforator mapping; Microsurgery; anatomical study
# Manuscript

## Introduction

Recent microsurgical reconstruction techniques benefit from the use of cutaneous and perforator flaps that spare the donor sites. Although many studies using perforator vessels exist in rat model (1–7), none describes the precise location of the vessels (origin and arrival to the skin), the caliber of the perforators, and the length of the pedicles. The interest in setting up an anatomical atlas collating these different data for the main rat perforator vessels will greatly simplify future studies and will become a unique landmark for the rat perforator model.

## Material and methods

Our study was conducted in the laboratory of experimental studies in compliance with requirements set forth # 2021120916359622 by the local Ethics Committee for Animal Experiments at our university. We performed an anatomical study on 10 Wistar Albino rats (five males, five females from Janvier labs; Le Genest-Saint-Isle; France), with an average weight of 322g [min 285; max 270; med 318.5], 10 weeks old on average [min 8; max 12; med 10]. Rats were euthanized according to institutional recommendations by gas anesthesia with isoflurane 5L/min (Vetflurane®; Virbac, France) followed by intracardiac injection of 1cc sodium pentobarbital (Euthasol Vet®; Dechra, France).

Immediately after euthanasia, the rats were weighed, fully shorn, and set up for anatomical study. Seven different vessels per side were dissected and analyzed, i.e. 14 vessels per animal, and 140 cutaneous and perforator vessels in total.
# Manuscript

## Introduction

Recent microsurgical reconstruction techniques benefit from the use of cutaneous and perforator flaps that spare the donor sites. Although many studies using perforator vessels exist in rat model (1–7), none describes the precise location of the vessels (origin and arrival to the skin), the caliber of the perforators, and the length of the pedicles. The interest in setting up an anatomical atlas collating these different data for the main rat perforator vessels will greatly simplify future studies and will become a unique landmark for the rat perforator model.

## Material and methods

Our study was conducted in the laboratory of experimental studies in compliance with requirements set forth # 2021120916359622 by the local Ethics Committee for Animal Experiments at our university. We performed an anatomical study on 10 Wistar Albino rats (five males, five females from Janvier labs; Le Genest-Saint-Isle; France), with an average weight of 322g [min 285; max 270; med 318.5], 10 weeks old on average [min 8; max 12; med 10]. Rats were euthanized according to institutional recommendations by gas anesthesia with isoflurane 5L/min (Vetflurane®; Virbac, France) followed by intracardiac injection of 1cc sodium pentobarbital (Euthasol Vet®; Dechra, France).

Immediately after euthanasia, the rats were weighed, fully shorn, and set up for anatomical study. Seven different vessels per side were dissected and analyzed, i.e. 14 vessels per animal, and 140 cutaneous and perforator vessels in total.
The dissected vessels were the most frequently found in the literature: posterior thigh (PT), deep circumflex iliac (DCI), posterior intercostal (PIC), lateral thoracic (LT), superficial inferior epigastric (SIE), and cranial epigastric (CE) vessels (1,5,8–12). For each dissected vessel, the external caliber of the vessels at the level of its emergence from the source vessel and the length of the pedicle were measured with a micrometer ruler (Shinwa Rules Co. Ltd., Tsubame, Japan), and the position of the origin, as well as the position of their arrival at the skin, was plotted on the skin surface.

We defined the orthonormal axis according to anatomical landmarks (for DCI, PIC, and PT vessels: median dorsal Y-axis between the nuchal flexion fold and the root of the tail, the X-axis passes orthogonally through the middle of the Y-axis. For LT vessels: Y-axis from the middle of the body and X-axis orthogonal passing through the xiphoid process. For SIE vessels: median ventral Y-axis between the xiphoid process and the pubis, orthogonal X-axis passing through the middle of the Y-axis. For EC vessels: the Y-axis was vertically medial oriented towards distality, and the X-axis passed perpendicularly through the xiphoid process) (Figure 1).

The locations were measured along these axes using the graduated ruler. All the coordinates found were analyzed in point clouds to define the origin and position of arrival at the skin. The average measures are represented by crosses, and ellipses that mark the average area of interest between the minimum and maximum values.

## Results

We describe our results by detailing the study parameters for each vessel studied in the manner of an atlas accompanied by a photograph of the landmarks used, the mean skin projection, and the skin projection cloud of the
The dissected vessels were the most frequently found in the literature: posterior thigh (PT), deep circumflex iliac (DCI), posterior intercostal (PIC), lateral thoracic (LT), superficial inferior epigastric (SIE), and cranial epigastric (CE) vessels (1,5,8–12). For each dissected vessel, the external caliber of the vessels at the level of its emergence from the source vessel and the length of the pedicle were measured with a micrometer ruler (Shinwa Rules Co. Ltd., Tsubame, Japan), and the position of the origin, as well as the position of their arrival at the skin, was plotted on the skin surface.

We defined the orthonormal axis according to anatomical landmarks (for DCI, PIC, and PT vessels: median dorsal Y-axis between the nuchal flexion fold and the root of the tail, the X-axis passes orthogonally through the middle of the Y-axis. For LT vessels: Y-axis from the middle of the body and X-axis orthogonal passing through the xiphoid process. For SIE vessels: median ventral Y-axis between the xiphoid process and the pubis, orthogonal X-axis passing through the middle of the Y-axis. For EC vessels: the Y-axis was vertically medial oriented towards distality, and the X-axis passed perpendicularly through the xiphoid process) (Figure 1).

The locations were measured along these axes using the graduated ruler. All the coordinates found were analyzed in point clouds to define the origin and position of arrival at the skin. The average measures are represented by crosses, and ellipses that mark the average area of interest between the minimum and maximum values.

## Results

We describe our results by detailing the study parameters for each vessel studied in the manner of an atlas accompanied by a photograph of the landmarks used, the mean skin projection, and the skin projection cloud of the
vessel location. We did not find significant differences in perforator
anatomy/characteristics between the male and female animals.

### Posterior thigh (PT) perforator vessels

The posterior thigh perforator vessels include a single perforator artery arising from the biceps femoris muscle, a few millimeters [min 0.7mm; max 2.3mm; med 1.8mm] distal from the intersection of the gluteus maximus and the biceps femoris muscles. The musculocutaneous perforator artery arises from the caudal femoral artery, which itself arises from the popliteal artery (1) (5).

Data are summarized in Table 1. The path of the perforator vessel is vertical and slightly oblique laterally from cranial to distal. Figure 2 (a-f) illustrates the measures. Analysis of the data for the 20 PTPF perforator vessels in a scatter plot revealed a mean position of the pedicle birth at (-24;-61) on the left and (24;-62) on the right (Figure 3a). The arrival at the skin was found on average at (-27;-65) on the left and (25;-67) on the right.

### Deep circumflex iliac (DCI) perforator vessels

The deep circumflex iliac cutaneous vessels arise from the iliolumbar pedicle intraperitoneally at the lateral aspect of the abdominal aorta and inferior vena cava, after crossing the abdominal wall giving a cutaneous vascular pedicle passing between the superficial gluteal muscle and the lateral wall with the external oblique muscle (13) (14).

Data are summarized in Table 1. The path of the vessel destined for the skin is oblique from lateral to medial and is directed globally towards the median vertical line of the reference frame.

Analysis of the data for the 20 DCI vessels in a point cloud revealed an average positioning of the pedicle origin at (-27;-31) on the left and (24;-28)
vessel location. We did not find significant differences in perforator
anatomy/characteristics between the male and female animals.

### Posterior thigh (PT) perforator vessels

The posterior thigh perforator vessels include a single perforator artery arising from the biceps femoris muscle, a few millimeters [min 0.7mm; max 2.3mm; med 1.8mm] distal from the intersection of the gluteus maximus and the biceps femoris muscles. The musculocutaneous perforator artery arises from the caudal femoral artery, which itself arises from the popliteal artery (1) (5).

Data are summarized in Table 1. The path of the perforator vessel is vertical and slightly oblique laterally from cranial to distal. Figure 2 (a-f) illustrates the measures. Analysis of the data for the 20 PTPF perforator vessels in a scatter plot revealed a mean position of the pedicle birth at (-24;-61) on the left and (24;-62) on the right (Figure 3a). The arrival at the skin was found on average at (-27;-65) on the left and (25;-67) on the right.

### Deep circumflex iliac (DCI) perforator vessels

The deep circumflex iliac cutaneous vessels arise from the iliolumbar pedicle intraperitoneally at the lateral aspect of the abdominal aorta and inferior vena cava, after crossing the abdominal wall giving a cutaneous vascular pedicle passing between the superficial gluteal muscle and the lateral wall with the external oblique muscle (13) (14).

Data are summarized in Table 1. The path of the vessel destined for the skin is oblique from lateral to medial and is directed globally towards the median vertical line of the reference frame.

Analysis of the data for the 20 DCI vessels in a point cloud revealed an average positioning of the pedicle origin at (-27;-31) on the left and (24;-28)
on the right (Figure 3b). The arrival at the skin was found on average at (-22;-33) on the left and (18;-28) on the right. Figure 2b illustrates the measures.

## Posterior intercostal perforator vessels (PIC)

The intercostal perforator vessels arise from the intercostal spaces 11-12 (13). There are many small perforators, but only one is constantly predominant and worthy of interest. The musculocutaneous perforator arises from the intercostal vessels arising from the abdominal aorta and the inferior vena cava (13). Data are summarized in Table 1. The path of the perforator vessel is vertical and discreetly oblique from lateral to medial and constantly heading towards the [0;0] mark of our reference frame.

Analysis of the data for the 20 PIC perforator vessels in a point cloud revealed an average positioning of the pedicle birth at (-27;22) on the left and (21;21) on the right (Figure 3c-d). The arrival at the skin was found on average at (-15;11) on the left and (13;9) on the right. Figure 2c illustrates the measures and summarized the average data for the back perforators.

## Lateral thoracic perforator vessels

The lateral thoracic perforator vessels arise from the thoracic common vessels below the Cutaneous Maximus muscle. The dissection continued to the lateral thoracic artery and common thoracic artery then the axillary artery. The veins ran in parallel to their arterial counterparts (15)(10,13)(16). Their path, birth coordinates, and arrival at the skin are the most variable of the vessels studied in our study. In this case, the source artery (lateral thoracic artery) is dissected and taken into account in the measurement of the pedicle length. Indeed, the perforator vessels strictly defined as such only measure a few millimeters and cannot be used alone without the source artery for
on the right (Figure 3b). The arrival at the skin was found on average at (-22;-33) on the left and (18;-28) on the right. Figure 2b illustrates the measures.

## Posterior intercostal perforator vessels (PIC)

The intercostal perforator vessels arise from the intercostal spaces 11-12 (13). There are many small perforators, but only one is constantly predominant and worthy of interest. The musculocutaneous perforator arises from the intercostal vessels arising from the abdominal aorta and the inferior vena cava (13). Data are summarized in Table 1. The path of the perforator vessel is vertical and discreetly oblique from lateral to medial and constantly heading towards the [0 ; 0] mark of our reference frame.

Analysis of the data for the 20 PIC perforator vessels in a point cloud revealed an average positioning of the pedicle birth at (-27;22) on the left and (21;21) on the right (Figure 3c-d). The arrival at the skin was found on average at (-15;11) on the left and (13;9) on the right. Figure 2c illustrates the measures and summarized the average data for the back perforators.

## Lateral thoracic perforator vessels

The lateral thoracic perforator vessels arise from the thoracic common vessels below the Cutaneous Maximus muscle. The dissection continued to the lateral thoracic artery and common thoracic artery then the axillary artery. The veins ran in parallel to their arterial counterparts (15)(10,13)(16). Their path, birth coordinates, and arrival at the skin are the most variable of the vessels studied in our study. In this case, the source artery (lateral thoracic artery) is dissected and taken into account in the measurement of the pedicle length. Indeed, the perforator vessels strictly defined as such only measure a few millimeters and cannot be used alone without the source artery for
microsurgical model purposes. Data are summarized in Table 1. The path of
the perforator vessel is very variable, if an average path is to be reported, it
would be oblique downward and forward crossing the vertical midline of the
reference frame. Analysis of the data for the 20 LT perforator vessels in a
point cloud revealed a mean position of the pedicle birth at (-10;35) on the left
and (-11;34) on the right. The arrival at the skin was found on average at
(9;26) on the left and (9;24) on the right. Figure 4a-b illustrates the measures.

Superficial inferior epigastric vessels

Vessels of cutaneous destination SIE arise from the femoral artery
approximately 10mm below the inguinal ligament (16) and run to the skin of
the inferolateral abdominal quadrant. The perforator vessel path is vertical
and internally oblique from distal to cranial. Data are summarized in Table 1.
Analysis of the data for the 20 SIE perforator vessels in a scatter plot revealed
an average positioning of the pedicle origin at (20;-32) on the left and (-23;-
30) on the right. The arrival at the skin was found on average at (16;-24) on
the left and (-17;-24) on the right. We can simplify schematically the origin of
the perforator vessels in the middle of the inguinal fold and localization of the
arrival at the skin in the middle of the line joining the previous point and the
point (0;0) of the reference frame. Figure 4c illustrates the measures.

Cranial epigastric perforators vessels

The cranial epigastric vessels arise from the internal thoracic vessels, which
become the cranial epigastric vessels around the xiphoid process (16). They
originate at coordinates (5;0) and (-5;0) consistently. Data are summarized in
Table 1. The pedicle length is measured from the origin of the source vessel
to the most constant and largest caliber perforator (P2). The path of the
microsurgical model purposes. Data are summarized in Table 1. The path of the perforator vessel is very variable, if an average path is to be reported, it would be oblique downward and forward crossing the vertical midline of the reference frame. Analysis of the data for the 20 LT perforator vessels in a point cloud revealed a mean position of the pedicle birth at (-10;35) on the left and (-11;34) on the right. The arrival at the skin was found on average at (9;26) on the left and (9;24) on the right. Figure 4a-b illustrates the measures.

## Superficial inferior epigastric vessels

Vessels of cutaneous destination SIE arise from the femoral artery approximately 10mm below the inguinal ligament (16) and run to the skin of the inferolateral abdominal quadrant. The perforator vessel path is vertical and internally oblique from distal to cranial. Data are summarized in Table 1. Analysis of the data for the 20 SIE perforator vessels in a scatter plot revealed an average positioning of the pedicle origin at (20;-32) on the left and (-23;-30) on the right. The arrival at the skin was found on average at (16;-24) on the left and (-17;-24) on the right. We can simplify schematically the origin of the perforator vessels in the middle of the inguinal fold and localization of the arrival at the skin in the middle of the line joining the previous point and the point (0;0) of the reference frame. Figure 4c illustrates the measures.

## Cranial epigastric perforators vessels

The cranial epigastric vessels arise from the internal thoracic vessels, which become the cranial epigastric vessels around the xiphoid process (16). They originate at coordinates (5;0) and (-5;0) consistently. Data are summarized in Table 1. The pedicle length is measured from the origin of the source vessel to the most constant and largest caliber perforator (P2). The path of the
source vessel is constantly parallel to the midline, a few millimeters laterally.
The perforator itself is vertical and oblique from medial to lateral.

Analysis of the data from the 40 CE vessels in a point cloud revealed an average positioning of the birth of the P1 perforators at (6;19) on the left and (-6;19) on the right, of the P2 perforators at (6;27) on the left and (-7;28) on the left. The average arrival at the skin was found for P1 at (9;21) on the left and (-9;23) on the right, for P2 at (9;32) on the left and (-15;33) on the right.
Figure 4d illustrates the measures.

Discussion

Although microsurgery laboratory training reports the possibility of perforator
vessel dissection in rats, no data exist in the literature regarding an
anatomical dissection that reports the precise location of the birth of the
vessels of interest, their location in the skin, as well as the calibers and length
of the pedicle. The size of the vessels was found in only eight studies
(6,11,12,16–20) without specifying the measurement method, only
Qassemyar et al. (19) reported the use of a photograph and Image J version
1.43u software (Rasband, W.S., ImageJ, Bethesda, Maryland, USA) to
determine vessel caliber, Liu and al (11) and Lhuaire and al. (16) used a
Shinwa micrometric ruler (Shinwa Rules Co. Ltd., Tsubame, Japan) as in our
study.

There are only six studies in the literature reporting usable pedicle length in
microsurgical practice: CEP (17,21) PTPF (5,22), and SIEP (6,18). These
studies described only the pedicle length of the flap of interest.

A perforator atlas exists in human practice(23) and guides the various studies
and works by indicating the locations of the perforator vessels according to
anatomical landmarks. Inspired by this work and as well as the democratized
source vessel is constantly parallel to the midline, a few millimeters laterally.

The perforator itself is vertical and oblique from medial to lateral.

Analysis of the data from the 40 CE vessels in a point cloud revealed an average positioning of the birth of the P1 perforators at (6;19) on the left and (-6;19) on the right, of the P2 perforators at (6;27) on the left and (-7;28) on the left. The average arrival at the skin was found for P1 at (9;21) on the left and (-9;23) on the right, for P2 at (9;32) on the left and (-15;33) on the right.

Figure 4d illustrates the measures.

## Discussion

Although microsurgery laboratory training reports the possibility of perforator vessel dissection in rats, no data exist in the literature regarding an anatomical dissection that reports the precise location of the birth of the vessels of interest, their location in the skin, as well as the calibers and length of the pedicle. The size of the vessels was found in only eight studies (6,11,12,16–20) without specifying the measurement method, only Qassemyar et al. (19) reported the use of a photograph and Image J version 1.43u software (Rasband, W.S., ImageJ, Bethesda, Maryland, USA) to determine vessel caliber, Liu and al (11) and Lhuaire and al. (16) used a Shinwa micrometric ruler (Shinwa Rules Co. Ltd., Tsubame, Japan) as in our study.

There are only six studies in the literature reporting usable pedicle length in microsurgical practice: CEP (17,21) PTPF (5,22), and SIEP (6,18). These studies described only the pedicle length of the flap of interest.

A perforator atlas exists in human practice(23) and guides the various studies and works by indicating the locations of the perforator vessels according to anatomical landmarks. Inspired by this work and as well as the democratized
use of this type of flap in clinical practice, we have produced this same atlas
on the rat animal model.

Even if perforator flaps are used in various indications, there are only a few perforator flap laboratory animal models. The rat remains a suitable animal because of its small size, easy care, universal availability, and low cost.

The first perforator flap in a rat animal model was identified by Oksar and al. (24). The abdominal skin flap was elevated based on the second perforator of the right superior cranial epigastric artery. Hallock and Rice (25) described the cranial epigastric perforator flap; they performed intramuscular dissection of the perforators and so-called this flap a “true” perforator flap (49). Kayano and al. (26) also developed the gluteal artery perforator flap and the thoracodorsal artery perforator flap as training models in rats. In contradistinction, we dissected several perforators on a single perforator (two perforators for the CE vessels) to the source pedicle through the muscle if needed.

## PT

The mapping by Bali and al. (12) remains unclear: the flap was elevated starting from its cranial aspect until the musculocutaneous perforator could be visualized with a perforator location at the gluteal fold. There are no precise anatomical landmarks reported.

Coskunfırat and al. (1) and Akyurek and al. (27) describe this model of a flap perforating the biceps femoris muscle. The position of the perforator is not described other than a location below the intersection of the biceps femoris and gluteus maximus. There is no indication of caliber or pedicle length.

Lese and al. (28) describes a skin landmark caudal line uniting the knee joint and the ischial tuberosity. A point two centimeters distal from the caudal
use of this type of flap in clinical practice, we have produced this same atlas
on the rat animal model.

Even if perforator flaps are used in various indications, there are only a few perforator flap laboratory animal models. The rat remains a suitable animal because of its small size, easy care, universal availability, and low cost.

The first perforator flap in a rat animal model was identified by Oksar and al. (24). The abdominal skin flap was elevated based on the second perforator of the right superior cranial epigastric artery. Hallock and Rice (25) described the cranial epigastric perforator flap; they performed intramuscular dissection of the perforators and so-called this flap a “true” perforator flap (49). Kayano and al. (26) also developed the gluteal artery perforator flap and the thoracodorsal artery perforator flap as training models in rats. In contradistinction, we dissected several perforators on a single perforator (two perforators for the CE vessels) to the source pedicle through the muscle if needed.

## PT

The mapping by Bali and al. (12) remains unclear: the flap was elevated starting from its cranial aspect until the musculocutaneous perforator could be visualized with a perforator location at the gluteal fold. There are no precise anatomical landmarks reported.

Coskunfırat and al. (1) and Akyurek and al. (27) describe this model of a flap perforating the biceps femoris muscle. The position of the perforator is not described other than a location below the intersection of the biceps femoris and gluteus maximus. There is no indication of caliber or pedicle length.

Lese and al. (28) describes a skin landmark caudal line uniting the knee joint and the ischial tuberosity. A point two centimeters distal from the caudal
border of the flap, corresponding to the perforator location. There is no more mapping or description.

Ozkan and al (5) describe the first free PT flap. It goes up to harvest the popliteal artery and the only measurement of caliber and pedicle length corresponds to the popliteal vessels therefore an increased pedicle harvest (40mm) does not correspond to the concept of a perforator flap, in this case, the vessels beyond the source vessels (caudal femoral artery) are harvested.

## DCI

The literature reports vessels of cutaneous destination of the lumbar region named indifferently cutaneous branch of the iliolumbar artery (29,30) or deep circumflex iliac perforator (31–33). Ozkan and al. (14) reports the possibility of raising an osteomusculocutaneous flap vascularized by iliolumbar vessels from the abdominal aorta and the vena cava. These vessels are cutaneous and arise approximately five millimeters lateral to the upper border of the iliac bone, which corresponds to our measurements. This is the only study that describes the location of the birth of the perforator with approximative anatomical landmarks.

## PIC

The PIC vessels remain the least well-described perforator vessels in the literature, no study describes precisely their location, pathway, and even less caliber and pedicle length. They are always described with the other perforator vessels of the dorsal region (LT, DCI, and PT) when using perforator flaps of the back. (9,34–38). These perforators remain interesting because they are placed in the middle of the dorsal region, often evaluated as a junction zone between the vascular territories (chokes vessels) (37) and they have one of the longest pedicles found in our study.

## LTPF
border of the flap, corresponding to the perforator location. There is no more mapping or description.

Ozkan and al (5) describe the first free PT flap. It goes up to harvest the popliteal artery and the only measurement of caliber and pedicle length corresponds to the popliteal vessels therefore an increased pedicle harvest (40mm) does not correspond to the concept of a perforator flap, in this case, the vessels beyond the source vessels (caudal femoral artery) are harvested.

## DCI

The literature reports vessels of cutaneous destination of the lumbar region named indifferently cutaneous branch of the iliolumbar artery (29,30) or deep circumflex iliac perforator (31–33). Ozkan and al. (14) reports the possibility of raising an osteomusculocutaneous flap vascularized by iliolumbar vessels from the abdominal aorta and the vena cava. These vessels are cutaneous and arise approximately five millimeters lateral to the upper border of the iliac bone, which corresponds to our measurements. This is the only study that describes the location of the birth of the perforator with approximative anatomical landmarks.

## PIC

The PIC vessels remain the least well-described perforator vessels in the literature, no study describes precisely their location, pathway, and even less caliber and pedicle length. They are always described with the other perforator vessels of the dorsal region (LT, DCI, and PT) when using perforator flaps of the back. (9,34–38). These perforators remain interesting because they are placed in the middle of the dorsal region, often evaluated as a junction zone between the vascular territories (chokes vessels) (37) and they have one of the longest pedicles found in our study.

## LTPF
Several studies use the lateral-thoracic vessels as the vascular supply of
dorsal skin flaps (15,35,39,40). Bali and al. (10) do not report any particular
dissection to locate the vessels; this identification remains empirical.

Cutaneous Maximus muscle regressed to various fascia layers in humans
through evolution, can be used as a muscle flap in the rat (41). As the lateral
thoracic artery supplies the entire muscle, muscle flap can be elevated on this
artery. Savas and al. (42) describes the LT perforator flap by dissecting
different-sized dorsal skin flaps and simply stating that most cranial
perforators of the lateral thoracic vessels were located on the superolateral
side. We report a large variability in the locations of birth and entrance to the
skin. This variability is not reported in the literature, on the other hand, no
mapping is found apart from an empirical localization on the midaxillary line
and 4th intercostal space for the perforator birth only.

SIEP

SIEP vessels are still the most commonly used in the literature because of their easy access, femoral vessels proximity, and a longer pedicle to be harvested, but above all of greater caliber (43) allowing a flow-through model (18)(44), a caliber of vessel accessible to microsurgical anastomoses, especially during training in super microsurgery (lymphatic-venous anastomoses, finger reimplantation, perforator-to-perforator flaps) (19) (45) (20).

CEP

In rats, the upper abdominal perforator vessels are called cranial epigastric,
whereas in humans they are called DIEP (deep inferior epigastric perforators).
DIEP vessels in the rat were also present, paired, and symmetrical. The artery
arose from the external iliac artery in its distal portion, a millimeter before the
inguinal ligament. Its course was cranial and directed laterally. Its path was
Several studies use the lateral-thoracic vessels as the vascular supply of
dorsal skin flaps (15,35,39,40). Bali and al. (10) do not report any particular
dissection to locate the vessels; this identification remains empirical.

Cutaneous Maximus muscle regressed to various fascia layers in humans
through evolution, can be used as a muscle flap in the rat (41). As the lateral
thoracic artery supplies the entire muscle, muscle flap can be elevated on this
artery. Savas and al. (42) describes the LT perforator flap by dissecting
different-sized dorsal skin flaps and simply stating that most cranial
perforators of the lateral thoracic vessels were located on the superolateral
side. We report a large variability in the locations of birth and entrance to the
skin. This variability is not reported in the literature, on the other hand, no
mapping is found apart from an empirical localization on the midaxillary line
and 4th intercostal space for the perforator birth only.

SIEP

SIEP vessels are still the most commonly used in the literature because of their easy access, femoral vessels proximity, and a longer pedicle to be harvested, but above all of greater caliber (43) allowing a flow-through model (18)(44), a caliber of vessel accessible to microsurgical anastomoses, especially during training in super microsurgery (lymphatic-venous anastomoses, finger reimplantation, perforator-to-perforator flaps) (19) (45) (20).

CEP

In rats, the upper abdominal perforator vessels are called cranial epigastric,
whereas in humans they are called DIEP (deep inferior epigastric perforators).
DIEP vessels in the rat were also present, paired, and symmetrical. The artery
arose from the external iliac artery in its distal portion, a millimeter before the
inguinal ligament. Its course was cranial and directed laterally. Its path was
intramuscular within the rectus abdominis muscle and in very close contact
with the muscle fibers. There were no perforators for cutaneous distribution
from this pedicle (16).

Between two and five CE perforators are crossing the rectus abdominis
muscle in the rat (46,47), the second one remains systematically the most
constant and the one with the biggest caliber (46,48–51), For this reason, we
chose to limit the measurements to the first two perforators to limit the number
of data and to maintain some clarity for these vessels.

Nevertheless, our study has several limitations; analyzing the vessels during
an anatomical study underestimates the caliber of the vessels because of less
vascular filling. Despite this, our work performs a "worst-case" evaluation of
these calibers and provides an approximation to serve as a guide for other
studies and works. The fact that this study was performed on a cadaver does
not change the evaluation of the location of the vessels and the assessment
of pedicle lengths. We can also discuss the use of imaging to map perforator
vessels in the rat model. The visualization of sub-millimetric vessels and the
technical complexity of using a CT angiography on such animals do not bring
any benefit compared to the gold standard which is anatomical dissection.

The panniculus carnosus is a very mobile plane of the detachment of the skin
and subcutaneous tissue (13). This extreme mobility can be a measurement
bias in terms of the evaluation of vessel location. We were obliged to place
the skin detachment physiologically to limit measurement bias due to this
mobility. Although position, vessel caliber, and pedicle length may vary with
rat size, our atlas evaluating data from rats weighing an average of 322g
matches rat weights which are commonly used in flap and bone studies.
microsurgical and super microsurgical training
intramuscular within the rectus abdominis muscle and in very close contact
with the muscle fibers. There were no perforators for cutaneous distribution
from this pedicle (16).

Between two and five CE perforators are crossing the rectus abdominis
muscle in the rat (46,47), the second one remains systematically the most
constant and the one with the biggest caliber (46,48–51), For this reason, we
chose to limit the measurements to the first two perforators to limit the number
of data and to maintain some clarity for these vessels.

Nevertheless, our study has several limitations; analyzing the vessels during
an anatomical study underestimates the caliber of the vessels because of less
vascular filling. Despite this, our work performs a "worst-case" evaluation of
these calibers and provides an approximation to serve as a guide for other
studies and works. The fact that this study was performed on a cadaver does
not change the evaluation of the location of the vessels and the assessment
of pedicle lengths. We can also discuss the use of imaging to map perforator
vessels in the rat model. The visualization of sub-millimetric vessels and the
technical complexity of using a CT angiography on such animals do not bring
any benefit compared to the gold standard which is anatomical dissection.

The panniculus carnosus is a very mobile plane of the detachment of the skin
and subcutaneous tissue (13). This extreme mobility can be a measurement
bias in terms of the evaluation of vessel location. We were obliged to place
the skin detachment physiologically to limit measurement bias due to this
mobility. Although position, vessel caliber, and pedicle length may vary with
rat size, our atlas evaluating data from rats weighing an average of 322g
matches rat weights which are commonly used in flap and bone studies.
microsurgical and super microsurgical training
The literature also reports descriptions of other perforator vessels of interest: gluteal artery perforator (GAP) (26,30), pubis perforator (52), anteromedial thigh perforator (AMT) (6,26), and saphenous vessels (3). We decided to limit our study to the six vascular pedicles most frequently encountered in the literature. Wei and al. (53) describes that a perforator vessel can only be named if it crosses a fascia and a muscle. For this reason, we differentiate perforator vessels as described by Wei (PT, PIC, LT, and CE) from skin vessels that do not cross muscle (DCI and SIE). The purpose is the same in the overall concept of respecting the donor areas in case of dissection of flaps corresponding to these pedicles.

Our study constitutes an anatomical reference concerning the rat animal model for future studies concerning the dissection and use of flaps, microsurgical practice (university diploma, micro, and super microsurgery), and the study of skin vascularization. Without an equivalent in the literature, this is an original work given the number of vessels studied (140).

## Conclusion

Our anatomical study describes the vascular calibers, pedicle lengths, and locations of birth and arrival at the skin of the perforator and cutaneous vessels (PT, DCI, PIC, LT, SIE, CE) in rats. This study is unique in the literature and lays the groundwork for future studies on this type of vessel.

## Declarations

### Availability of data and materials

The data sets generated and/or analyzed during the current study are available from the corresponding author upon request.
The literature also reports descriptions of other perforator vessels of interest: gluteal artery perforator (GAP) (26,30), pubis perforator (52), anteromedial thigh perforator (AMT) (6,26), and saphenous vessels (3). We decided to limit our study to the six vascular pedicles most frequently encountered in the literature. Wei and al. (53) describes that a perforator vessel can only be named if it crosses a fascia and a muscle. For this reason, we differentiate perforator vessels as described by Wei (PT, PIC, LT, and CE) from skin vessels that do not cross muscle (DCI and SIE). The purpose is the same in the overall concept of respecting the donor areas in case of dissection of flaps corresponding to these pedicles.

Our study constitutes an anatomical reference concerning the rat animal model for future studies concerning the dissection and use of flaps, microsurgical practice (university diploma, micro, and super microsurgery), and the study of skin vascularization. Without an equivalent in the literature, this is an original work given the number of vessels studied (140).

## Conclusion

Our anatomical study describes the vascular calibers, pedicle lengths, and locations of birth and arrival at the skin of the perforator and cutaneous vessels (PT, DCI, PIC, LT, SIE, CE) in rats. This study is unique in the literature and lays the groundwork for future studies on this type of vessel.

## Declarations

### Availability of data and materials

The data sets generated and/or analyzed during the current study are available from the corresponding author upon request.
**Competing interests**

The authors declare that they have no competing interests

**Fundings**

This research received no external funding.

**Authors' contributions**

UL and BC designed the study. UL collected the data. UL, BC, PP, and PC analyzed the data. UL and BC wrote the paper. PP, PC, and PW revised the article critically for important intellectual content. PC and PW supervised the project.

**Acknowledgments**

No financial support

**Conflict of interest**

None declared

**References**

1. Coskunfirat OK, İslamoğlu K, Özgentaş HE. Posterior Thigh Perforator-Based Flap: A New Experimental Model in Rats: Annals of Plastic Surgery. *marts* 2002;48(3):286-91.

2. Acartürk TO, Dinçyürek H, Dağlıoğlu K. Delay by Staged Elevation of Flaps and Importance of Inclusion of the Perforator Artery. *J Hand Microsurg. juin* 2015;7(1):1-5.

3. Aksam E, Aksam B, Demirseren ME, Yavuz HSO. Saphenous artery-based flap models in rats: new flap designs for experimental studies. *J Surg*
**Competing interests**

The authors declare that they have no competing interests

**Fundings**

This research received no external funding.

**Authors' contributions**

UL and BC designed the study. UL collected the data. UL, BC, PP, and PC analyzed the data. UL and BC wrote the paper. PP, PC, and PW revised the article critically for important intellectual content. PC and PW supervised the project.

**Acknowledgments**

No financial support

**Conflict of interest**

None declared

**References**

1. Coskunfirat OK, İslamoğlu K, Özgentaş HE. Posterior Thigh Perforator-Based Flap: A New Experimental Model in Rats: Annals of Plastic Surgery. *marts* 2002;48(3):286-91.

2. Acartürk TO, Dinçyürek H, Dağlıoğlu K. Delay by Staged Elevation of Flaps and Importance of Inclusion of the Perforator Artery. *J Hand Microsurg*. *juin* 2015;7(1):1-5.

3. Aksam E, Aksam B, Demirseren ME, Yavuz HSO. Saphenous artery-based flap models in rats: new flap designs for experimental studies. *J Surg*
Res. déc 2016;206(2):355-62.

4. Erdem M, Tiftikcioglu Y, Tatar BE, Kılıç KD, Uyanıkgil Y, Gürler T. The Effect of Botulinum Toxin on Flap Viability of the Posterior Thigh Perforator Flap in Rats. Journal of Surgical Research. mai 2021;261:85-94.

5. Ozkan O, Coskunfirat OK, Ozgentas HE. A new experimental flap model: free muscle perforator flap. Ann Plast Surg. déc 2003;51(6):603-6.

6. Rodríguez A, Álvarez Á, Aguirrezabalaga J, Martelo F. The Anteromedial Thigh Flap as a Training Model of a Perforator Flap in Rat. J reconstr Microsurg. juill 2007;23(5):251-5.

7. Than PA, Davis CR, Rennert RC, Morrison SD, Findlay MW, Kay MA, et al. Selective Microvascular Tissue Transfection Using Minicircle DNA for Systemic Delivery of Human Coagulation Factor IX in a Rat Model Using a Therapeutic Flap. Plastic & Reconstructive Surgery. janv 2022;149(1):117-29.

8. Park J-W, Mun G-H. Comparative analysis of the effect of antihypertensive drugs on the survival of perforator flaps in a rat model. Microsurgery. mars 2018;38(3):310-7.

9. Xi S, Cheng S, Lou J, Qiu L, Yang Q, Yu W, et al. A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap: Plastic and Reconstructive Surgery. févr 2019;143(2):322e-8e.

10. Bali U, Gungor M, Yoleri L. Lateral thoracic artery perforator-based flap: a new experimental model. Journal of Surgical Research. févr 2016;200(2):738-42.

11. Liu H-L. Microvascular Anastomosis of Submillimeter Vessels—A Training Model in Rats. J Hand Microsurg. 5 sept 2016;05(01):14-7.

12. Ozkan Omer, Koshima I, Gonda K. A Supermicrosurgical Flap Model in
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4. Erdem M, Tiftikcioglu Y, Tatar BE, Kılıç KD, Uyanıkgil Y, Gürler T. The Effect of Botulinum Toxin on Flap Viability of the Posterior Thigh Perforator Flap in Rats. Journal of Surgical Research. mai 2021;261:85-94.

5. Ozkan O, Coskunfirat OK, Ozgentas HE. A new experimental flap model: free muscle perforator flap. Ann Plast Surg. déc 2003;51(6):603-6.

6. Rodríguez A, Álvarez Á, Aguirrezabalaga J, Martelo F. The Anteromedial Thigh Flap as a Training Model of a Perforator Flap in Rat. J reconstr Microsurg. juill 2007;23(5):251-5.

7. Than PA, Davis CR, Rennert RC, Morrison SD, Findlay MW, Kay MA, et al. Selective Microvascular Tissue Transfection Using Minicircle DNA for Systemic Delivery of Human Coagulation Factor IX in a Rat Model Using a Therapeutic Flap. Plastic & Reconstructive Surgery. janv 2022;149(1):117-29.

8. Park J-W, Mun G-H. Comparative analysis of the effect of antihypertensive drugs on the survival of perforator flaps in a rat model. Microsurgery. mars 2018;38(3):310-7.

9. Xi S, Cheng S, Lou J, Qiu L, Yang Q, Yu W, et al. A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap: Plastic and Reconstructive Surgery. févr 2019;143(2):322e-8e.

10. Bali U, Gungor M, Yoleri L. Lateral thoracic artery perforator-based flap: a new experimental model. Journal of Surgical Research. févr 2016;200(2):738-42.

11. Liu H-L. Microvascular Anastomosis of Submillimeter Vessels—A Training Model in Rats. J Hand Microsurg. 5 sept 2016;05(01):14-7.

12. Ozkan Omer, Koshima I, Gonda K. A Supermicrosurgical Flap Model in
the Rat: A Free True Abdominal Perforator Flap with a Short Pedicle: Plastic and Reconstructive Surgery. févr 2006;117(2):479-85.

13. Iwaki T. A color atlas of sectional anatomy of the mouse. 2001.

14. Ozkan Omer, Akyurek M, Safak T, Kayikçioğlu A, Güler G, Erk Y. A New Flap Model in Rats: Iliac Osteomusculocutaneous Flap: Annals of Plastic Surgery. août 2001;47(2):161-7.

15. Bali U, Aydemir I, Keçeci Y, Yoleri L, Tuğlu Mİ. Effects of oxidative stress and apoptosis on vascularity and viability of perforator flaps. Biotechnic & Histochemistry. 3 oct 2021;96(7):526-35.

16. Lhuaire M, Hivelin M, Hunsinger V, Derder M, Delmas V, Abrahams P, et al. Descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles in three domestic mammals: A comparative study. Morphologie. sept 2021;105(350):217-26.

17. Ozkan O, Koshima I, Gonda K. A supermicrosurgical flap model in the rat: a free true abdominal perforator flap with a short pedicle. Plast Reconstr Surg. févr 2006;117(2):479-85.

18. Ozkan O, Coşkunfirat OK, Ozgentaş HE, Dikici MB. New experimental flap model in the rat: free flow-through epigastric flap. Microsurgery. 2004;24(6):454-8.

19. Qasemyar Q, Sinna R. De la microchirurgie à la « supermicrochirurgie » : étude expérimentale de faisabilité et perspectives. Annales de Chirurgie Plastique Esthétique. déc 2011;56(6):518-27.

20. Mofikoya B, Ugburo A, Bankole O. Microvascular Anastomosis of Vessels Less Than 0.5 mm in Diameter: A Supermicrosurgery Training Model in Lagos, Nigeria. J Hand Microsurg. 5 sept 2016;03(01):15-7.

21. Chang C-H, Lim S-Y, Pyon J-K, Bang S-I, Oh K-S, Mun G-H. The
the Rat: A Free True Abdominal Perforator Flap with a Short Pedicle: Plastic and Reconstructive Surgery. févr 2006;117(2):479-85.

13. Iwaki T. A color atlas of sectional anatomy of the mouse. 2001.

14. Ozkan Omer, Akyurek M, Safak T, Kayikçioğlu A, Güler G, Erk Y. A New Flap Model in Rats: Iliac Osteomusculocutaneous Flap: Annals of Plastic Surgery. août 2001;47(2):161-7.

15. Bali U, Aydemir I, Keçeci Y, Yoleri L, Tuğlu Mİ. Effects of oxidative stress and apoptosis on vascularity and viability of perforator flaps. Biotechnic & Histochemistry. 3 oct 2021;96(7):526-35.

16. Lhuaire M, Hivelin M, Hunsinger V, Derder M, Delmas V, Abrahams P, et al. Descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles in three domestic mammals: A comparative study. Morphologie. sept 2021;105(350):217-26.

17. Ozkan O, Koshima I, Gonda K. A supermicrosurgical flap model in the rat: a free true abdominal perforator flap with a short pedicle. Plast Reconstr Surg. févr 2006;117(2):479-85.

18. Ozkan O, Coşkunfirat OK, Ozgentaş HE, Dikici MB. New experimental flap model in the rat: free flow-through epigastric flap. Microsurgery. 2004;24(6):454-8.

19. Qasemyar Q, Sinna R. De la microchirurgie à la « supermicrochirurgie » : étude expérimentale de faisabilité et perspectives. Annales de Chirurgie Plastique Esthétique. déc 2011;56(6):518-27.

20. Mofikoya B, Ugburo A, Bankole O. Microvascular Anastomosis of Vessels Less Than 0.5 mm in Diameter: A Supermicrosurgery Training Model in Lagos, Nigeria. J Hand Microsurg. 5 sept 2016;03(01):15-7.

21. Chang C-H, Lim S-Y, Pyon J-K, Bang S-I, Oh K-S, Mun G-H. The
influence of pedicle length on the viability of twisted perforator flaps in rats. J Reconstr Microsurg. nov 2009;25(9):533-8.

22. Bektas G, Ozkan O, Cinpolat A, Bassorgun I, Ciftcioglu M, Ozkan O. Comparing the Effects of Pedicle Torsion on Axial or Perforator Flaps; Improving the Perforator Flap Resistance to Pedicle Torsion with Delay Phenomenon. J reconstr Microsurg. 3 mars 2014;30(08):531-8.

23. Boucher F. Atlas des artères perforantes de la peau, du tronc et des membres. 2015.

24. Okşar HS, Coşkunfırat OK, Özgentaş HE. Perforator-Based Flap in Rats: A New Experimental Model: Plastic and Reconstructive Surgery. juill 2001;108(1):125-31.

25. Hallock GG, Rice DC. Cranial epigastric perforator flap: a rat model of a true perforator flap. Ann Plast Surg. avr 2003;50(4):393-7.

26. Kayano S, Nakagawa M, Nagamatsu S, Koizumi T, Akazawa S. Why not perforator flap training models in rats? Journal of Plastic, Reconstructive & Aesthetic Surgery. févr 2010;63(2):e134-5.

27. Akyürek M, Şafak T, Manavbaşl İ, Keçik A. A Rat Musculocutaneous Flap Model: The Biceps Femoris Musculocutaneous Flap: Annals of Plastic Surgery. sept 2000;45(3):305-12.

28. Lese I, Graf DA, Tsai C, Taddeo A, Matter MT, Constantinescu MA, et al. Bioactive nanoparticle-based formulations increase survival area of perforator flaps in a rat model. Harhaus L, éditeur. PLoS ONE. 26 nov 2018;13(11):e0207802.

29. Qing L, Lei P, Tang J, Wu P, Wang L, Xie J, et al. Inflammatory response associated with choke vessel remodeling in the extended perforator flap model. Experimental and Therapeutic Medicine. mai 2017;13(5):2012-8.
influence of pedicle length on the viability of twisted perforator flaps in rats. J Reconstr Microsurg. nov 2009;25(9):533-8.

22. Bektas G, Ozkan O, Cinpolat A, Bassorgun I, Ciftcioglu M, Ozkan O. Comparing the Effects of Pedicle Torsion on Axial or Perforator Flaps; Improving the Perforator Flap Resistance to Pedicle Torsion with Delay Phenomenon. J reconstr Microsurg. 3 mars 2014;30(08):531-8.

23. Boucher F. Atlas des artères perforantes de la peau, du tronc et des membres. 2015.

24. Okşar HS, Coşkunfırat OK, Özgentaş HE. Perforator-Based Flap in Rats: A New Experimental Model: Plastic and Reconstructive Surgery. juill 2001;108(1):125-31.

25. Hallock GG, Rice DC. Cranial epigastric perforator flap: a rat model of a true perforator flap. Ann Plast Surg. avr 2003;50(4):393-7.

26. Kayano S, Nakagawa M, Nagamatsu S, Koizumi T, Akazawa S. Why not perforator flap training models in rats? Journal of Plastic, Reconstructive & Aesthetic Surgery. févr 2010;63(2):e134-5.

27. Akyürek M, Şafak T, Manavbaşl İ, Keçik A. A Rat Musculocutaneous Flap Model: The Biceps Femoris Musculocutaneous Flap: Annals of Plastic Surgery. sept 2000;45(3):305-12.

28. Lese I, Graf DA, Tsai C, Taddeo A, Matter MT, Constantinescu MA, et al. Bioactive nanoparticle-based formulations increase survival area of perforator flaps in a rat model. Harhaus L, éditeur. PLoS ONE. 26 nov 2018;13(11):e0207802.

29. Qing L, Lei P, Tang J, Wu P, Wang L, Xie J, et al. Inflammatory response associated with choke vessel remodeling in the extended perforator flap model. Experimental and Therapeutic Medicine. mai 2017;13(5):2012-8.
30. Zhuang Y, Xie Y, Wu Z, Xue L, Tang Y, Zheng H, et al. Hemodynamic Study of Three Patterns of Flaps on Rats with a Novel Panoramic Photographing Technique Involved: Plastic and Reconstructive Surgery. oct 2016;138(4):653e-65e.

31. Chang H, Nobuaki I, Minabe T, Nakajima H. Comparison of Three Different Supercharging Procedures in a Rat Skin Flap Model: Plastic and Reconstructive Surgery. janv 2004;113(1):277-83.

32. Park SO, Cho J, Imanishi N, Chang H. Effect of distal venous drainage on the survival of four-territory flaps with no pedicle vein: Results from a rat model. Journal of Plastic, Reconstructive & Aesthetic Surgery. mars 2018;71(3):410-5.

33. Chang H, Minn KW, Imanishi N, Minabe T, Nakajima H. Effect of Venous Superdrainage on a Four-Territory Skin Flap Survival in Rats: Plastic and Reconstructive Surgery. juin 2007;119(7):2046-51.

34. Chen M, Li X, Jiang Z, Gong X. Visualizing the Pharmacologic Preconditioning Effect of Botulinum Toxin Type A by Infrared Thermography in a Rat Pedicled Perforator Island Flap Model. Plast Reconstr Surg. déc 2019;144(6):1016e-24e.

35. He Z, Gao W, Li J, Lin K, Lyu L, Li Z, et al. [A perforator-based dorsal flap's experimental research in the rat]. Zhonghua Zheng Xing Wai Ke Za Zhi. janv 2014;30(1):40-4.

36. Ding J, Feng X, Gao W, Yan H, Tao X, Wang L, et al. Comparison of a Small Central versus a Large Peripheral Perforator in a Rat Model of Extended Dorsal Three-Vascular Territory Perforator Flap: Plastic and Reconstructive Surgery. févr 2017;139(2):434e-43e.

37. Zheng J, Xi S, Ding M, Li H, Xu W, Tang M, et al. Effects of Venous
30. Zhuang Y, Xie Y, Wu Z, Xue L, Tang Y, Zheng H, et al. Hemodynamic Study of Three Patterns of Flaps on Rats with a Novel Panoramic Photographing Technique Involved: Plastic and Reconstructive Surgery. oct 2016;138(4):653e-65e.

31. Chang H, Nobuaki I, Minabe T, Nakajima H. Comparison of Three Different Supercharging Procedures in a Rat Skin Flap Model: Plastic and Reconstructive Surgery. janv 2004;113(1):277-83.

32. Park SO, Cho J, Imanishi N, Chang H. Effect of distal venous drainage on the survival of four-territory flaps with no pedicle vein: Results from a rat model. Journal of Plastic, Reconstructive & Aesthetic Surgery. mars 2018;71(3):410-5.

33. Chang H, Minn KW, Imanishi N, Minabe T, Nakajima H. Effect of Venous Superdrainage on a Four-Territory Skin Flap Survival in Rats: Plastic and Reconstructive Surgery. juin 2007;119(7):2046-51.

34. Chen M, Li X, Jiang Z, Gong X. Visualizing the Pharmacologic Preconditioning Effect of Botulinum Toxin Type A by Infrared Thermography in a Rat Pedicled Perforator Island Flap Model. Plast Reconstr Surg. déc 2019;144(6):1016e-24e.

35. He Z, Gao W, Li J, Lin K, Lyu L, Li Z, et al. [A perforator-based dorsal flap's experimental research in the rat]. Zhonghua Zheng Xing Wai Ke Za Zhi. janv 2014;30(1):40-4.

36. Ding J, Feng X, Gao W, Yan H, Tao X, Wang L, et al. Comparison of a Small Central versus a Large Peripheral Perforator in a Rat Model of Extended Dorsal Three-Vascular Territory Perforator Flap: Plastic and Reconstructive Surgery. févr 2017;139(2):434e-43e.

37. Zheng J, Xi S, Ding M, Li H, Xu W, Tang M, et al. Effects of Venous
Superdrainage and Arterial Supercharging on Dorsal Perforator Flap in a Rat Model. Paulus P, éditeur. PLoS ONE. 11 août 2016;11(8):e0160942.

38. Zhuang Y, Hu S, Wu D, Tang M, Xu DC. A Novel In Vivo Technique for Observations of Choke Vessels in a Rat Skin Flap Model. Plastic & Reconstructive Surgery. août 2012;130(2):308-17.

39. Wu H, Zhang C, Chen Z, Lou J, Ding J, Wang L, et al. Distal Arterialized Venous Supercharging Improves Perfusion and Survival in an Extended Dorsal Three-Perforasome Perforator Flap Rat Model. Plastic & Reconstructive Surgery. juin 2021;147(6):957e-66e.

40. Özkan Ö, Özkan Ö. Cross-site anastomosis for a free flap with a long pedicle in the rat. Journal of Plastic, Reconstructive & Aesthetic Surgery. sept 2009;62(9):1202-4.

41. Li X, Cooley BC, Gruel SM, Ye Z, Gould JS. Free flap transfer of the cutaneous maximus muscle in the rat: Comparison to the latissimus dorsi muscle flap. Microsurgery. 1992;13(4):208-13.

42. Savaş SA, Gorgulu T, Başsorgun Cİ, Akcal A. A new lateral thoracic artery perforator flap design with multiple vascular territories in rats. J Surg Res. mars 2017;209:70-8.

43. Yamashita S, Sugiyama N, Hasegawa K, Namba Y, Kimata Y. A Novel Model for Supermicrosurgery Training: The Superficial Inferior Epigastric Artery Flap in Rats. J reconstr Microsurg. nov 2008;24(08):537-43.

44. Chun J, Sterry T, Zhang W, Wolfeld M, Silver L, Teodorescu V, et al. Rat Epigastric Flow-Through Flap as a Modulated Arteriovenous Fistula: Model for the Radial Artery Flow-Through Flap in Distal Arterial Bypass. J reconstr Microsurg. 2003;19(06):387-91.

45. Miyamoto S, Sakuraba M, Asano T, Tsuchiya S, Hamamoto Y, Onoda
Superdrainage and Arterial Supercharging on Dorsal Perforator Flap in a Rat Model. Paulus P, éditeur. PLoS ONE. 11 août 2016;11(8):e0160942.

38. Zhuang Y, Hu S, Wu D, Tang M, Xu DC. A Novel In Vivo Technique for Observations of Choke Vessels in a Rat Skin Flap Model. Plastic & Reconstructive Surgery. août 2012;130(2):308-17.

39. Wu H, Zhang C, Chen Z, Lou J, Ding J, Wang L, et al. Distal Arterialized Venous Supercharging Improves Perfusion and Survival in an Extended Dorsal Three-Perforasome Perforator Flap Rat Model. Plastic & Reconstructive Surgery. juin 2021;147(6):957e-66e.

40. Özkan Ö, Özkan Ö. Cross-site anastomosis for a free flap with a long pedicle in the rat. Journal of Plastic, Reconstructive & Aesthetic Surgery. sept 2009;62(9):1202-4.

41. Li X, Cooley BC, Gruel SM, Ye Z, Gould JS. Free flap transfer of the cutaneous maximus muscle in the rat: Comparison to the latissimus dorsi muscle flap. Microsurgery. 1992;13(4):208-13.

42. Savaş SA, Gorgulu T, Başsorgun Cİ, Akcal A. A new lateral thoracic artery perforator flap design with multiple vascular territories in rats. J Surg Res. mars 2017;209:70-8.

43. Yamashita S, Sugiyama N, Hasegawa K, Namba Y, Kimata Y. A Novel Model for Supermicrosurgery Training: The Superficial Inferior Epigastric Artery Flap in Rats. J reconstr Microsurg. nov 2008;24(08):537-43.

44. Chun J, Sterry T, Zhang W, Wolfeld M, Silver L, Teodorescu V, et al. Rat Epigastric Flow-Through Flap as a Modulated Arteriovenous Fistula: Model for the Radial Artery Flow-Through Flap in Distal Arterial Bypass. J reconstr Microsurg. 2003;19(06):387-91.

45. Miyamoto S, Sakuraba M, Asano T, Tsuchiya S, Hamamoto Y, Onoda
S, et al. Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. J Plast Reconstr Aesthet Surg. juill 2010;63(7):1196-201.

46. Monahan J, Hwang BH, Kennedy JM, Chen W, Nguyen GK, Schooler WG, et al. Determination of a perfusion threshold in experimental perforator flap surgery using indocyanine green angiography. Ann Plast Surg. nov 2014;73(5):602-6.

47. Wang D, Chen W. Indocyanine Green Angiography for Continuously Monitoring Blood Flow Changes and Predicting Perfusion of Deep Inferior Epigastric Perforator Flap in Rats. Journal of Investigative Surgery. 21 avr 2021;34(4):393-400.

48. Zhang Y, Wang T, Wei J, He J, Wang T, Liu Y, et al. What's the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply? PLoS One. 2017;12(2):e0171651.

49. Demir A, Acar M, Yldz L, Karacalar A. The Effect of Twisting on Perforator Flap Viability: An Experimental Study in Rats. Annals of Plastic Surgery. févr 2006;56(2):186-9.

50. Keleş MK, DemİR A, Küçüker İ, Alici Ö. The effect of twisting on single and double based perforator flap viability: An experimental study in rats: Twisted Perforator Flaps. Microsurgery. sept 2014;34(6):464-9.

51. Coşkunfirat KO, Okşar SH, Özgentaş EH. Effect of the Delay Phenomenon in the Rat Single-Perforator-Based Abdominal Skin Flap Model: Annals of Plastic Surgery. juill 2000;45(1):42-7.

52. Chen W, Li Y-Q, Tang Y, Zhou C-D, Zhao M-X, Yang Z, et al. [Which vessel, the artery or the vein is more important in vascular supercharge: an
S, et al. Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model. J Plast Reconstr Aesthet Surg. juill 2010;63(7):1196-201.

46. Monahan J, Hwang BH, Kennedy JM, Chen W, Nguyen GK, Schooler WG, et al. Determination of a perfusion threshold in experimental perforator flap surgery using indocyanine green angiography. Ann Plast Surg. nov 2014;73(5):602-6.

47. Wang D, Chen W. Indocyanine Green Angiography for Continuously Monitoring Blood Flow Changes and Predicting Perfusion of Deep Inferior Epigastric Perforator Flap in Rats. Journal of Investigative Surgery. 21 avr 2021;34(4):393-400.

48. Zhang Y, Wang T, Wei J, He J, Wang T, Liu Y, et al. What's the remedy for the distal necrosis of DIEP flap, better venous drain or more arterial supply? PLoS One. 2017;12(2):e0171651.

49. Demir A, Acar M, Yldz L, Karacalar A. The Effect of Twisting on Perforator Flap Viability: An Experimental Study in Rats. Annals of Plastic Surgery. févr 2006;56(2):186-9.

50. Keleş MK, DemİR A, Küçüker İ, Alici Ö. The effect of twisting on single and double based perforator flap viability: An experimental study in rats: Twisted Perforator Flaps. Microsurgery. sept 2014;34(6):464-9.

51. Coşkunfirat KO, Okşar SH, Özgentaş EH. Effect of the Delay Phenomenon in the Rat Single-Perforator-Based Abdominal Skin Flap Model: Annals of Plastic Surgery. juill 2000;45(1):42-7.

52. Chen W, Li Y-Q, Tang Y, Zhou C-D, Zhao M-X, Yang Z, et al. [Which vessel, the artery or the vein is more important in vascular supercharge: an
investigation of vascular changes on rat abdominal supercharging flap
models]. Zhonghua Zheng Xing Wai Ke Za Zhi. janv 2013;29(1):40-4.

53. Wei F-C, Jain V, Suominen S, Chen H-C. Confusion among Perforator Flaps: What Is a True Perforator Flap?: Plastic and Reconstructive Surgery. mars 2001;107(3):874-6.
investigation of vascular changes on rat abdominal supercharging flap
models]. Zhonghua Zheng Xing Wai Ke Za Zhi. janv 2013;29(1):40-4.

53. Wei F-C, Jain V, Suominen S, Chen H-C. Confusion among Perforator Flaps: What Is a True Perforator Flap?: Plastic and Reconstructive Surgery. mars 2001;107(3):874-6.
<table><tr><td>Source vessel</td><td colspan="2">Caudal femoral artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.29 mm [min 0.20; max 0.45; med 0.25]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.41mm [min 0.20; max 0.80; med 0.35]</td></tr><tr><td>Pedicle length</td><td colspan="2">12.5mm [min 9; max 16; med 13]</td></tr><tr><td>Average vessel origin position</td><td>L (-24 ; -61)</td><td>R (24 ; -62)</td></tr><tr><td>Average position to the skin</td><td>L (-27 ; -65)</td><td>R (25 ; -67)</td></tr></table>

PT summary

<table><tr><td>Source vessel</td><td colspan="2">11-12nd Intercostal artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.28 mm [min 0.15; max 0.45; med 0.30]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.38 mm[min 0.20; max 0.70; med 0.35]</td></tr><tr><td>Pedicle length</td><td colspan="2">25.75 mm [min 15; max 42; med 25]</td></tr><tr><td>Average vessel origin position</td><td>L (-27 ;-22)</td><td>R (21 ;21)</td></tr><tr><td>Average position to the skin</td><td>L (-15 ;11)</td><td>R (13;9)</td></tr></table>

PIC summary

<table><tr><td>Source vessel</td><td colspan="2">Iliolumbar artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.32 mm [min 0.15; max 0.45; med 0.30]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.46 mm [min 0.20; max 0.95; med 0.43]</td></tr><tr><td>Pedicle length</td><td colspan="2">22.7 mm [min 15; max 32; med 24]</td></tr><tr><td>Average vessel origin position</td><td>L (-27 ;-31)</td><td>R (24 ;-28)</td></tr><tr><td>Average position to the skin</td><td>L (-22 ;-33)</td><td>R (18;-28)</td></tr></table>

DCI summary

<table><tr><td>Source vessel</td><td colspan="2">Lateral thoracic artery</td></tr><tr><td>Artery diameter</td><td colspan="2">0.39 mm [min 0.25; max 0.55; med 0.40]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.64 mm[min 0.35; max 0.90; med 0.68]</td></tr><tr><td>Pedicle length</td><td colspan="2">28.3 mm[min 20; max 40; med 27]</td></tr><tr><td>Average vessel origin position</td><td>L (-10 ;35)</td><td>R (-11 ;34)</td></tr><tr><td>Average position to the skin</td><td>L (9 ;26)</td><td>R (9 ;24)</td></tr></table>

LT summary

<table><tr><td>Source vessel</td><td colspan="2">Femoral artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.35 mm [min 0.25; max 0.45; med 0.35]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.62 mm [min 0.45; max 0.80; med 0.60]</td></tr><tr><td>Pedicle length</td><td colspan="2">22.1 mm [min 18; max 26; med 22]</td></tr><tr><td>Average vessel origin position</td><td>L (20 ;-32)</td><td>R (-23 ;-30)</td></tr><tr><td>Average position to the skin</td><td>L (16 ;-24)</td><td>R (-17;-24)</td></tr></table>

SIE summary

<table><tr><td>Source vessel</td><td colspan="2">Internal thoracic artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.29 mm [min 0.15; max 0.40; med 0.30]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.39 mm [min 0.20; max 0.50; med 0.40]</td></tr><tr><td>Pedicle length</td><td colspan="2">35.25 mm [min 24; max 50; med 34.50]</td></tr><tr><td>Average vessel origin position P1</td><td>L (6 ;19)</td><td>R (-6 ;19)</td></tr><tr><td>Average vessel origin position P2</td><td>L (6 ;27)</td><td>R (-7 ;28)</td></tr><tr><td>Average position to the skin P1</td><td>L (9 ;21)</td><td>R (-9;23)</td></tr><tr><td>Average position to the skin P2</td><td>L (9 ;32)</td><td>R (-15 ;33)</td></tr></table>

CE summary

<caption>Table 1: Data summary for PT, PIC, DCI, LT, SIE, and CE vessels</caption>
<table><tr><td>Source vessel</td><td colspan="2">Caudal femoral artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.29 mm [min 0.20; max 0.45; med 0.25]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.41mm [min 0.20; max 0.80; med 0.35]</td></tr><tr><td>Pedicle length</td><td colspan="2">12.5mm [min 9; max 16; med 13]</td></tr><tr><td>Average vessel origin position</td><td>L (-24 ; -61)</td><td>R (24 ; -62)</td></tr><tr><td>Average position to the skin</td><td>L (-27 ; -65)</td><td>R (25 ; -67)</td></tr></table>

PT summary

<table><tr><td>Source vessel</td><td colspan="2">11-12nd Intercostal artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.28 mm [min 0.15; max 0.45; med 0.30]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.38 mm [min 0.20; max 0.70; med 0.35]</td></tr><tr><td>Pedicle length</td><td colspan="2">25.75 mm [min 15; max 42; med 25]</td></tr><tr><td>Average vessel origin position</td><td>L (-27 ; -22)</td><td>R (21 ; 21)</td></tr><tr><td>Average position to the skin</td><td>L (-15 ; 11)</td><td>R (13;9)</td></tr></table>

PIC summary

<table><tr><td>Source vessel</td><td colspan="2">Iliolumbar artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.32 mm [min 0.15; max 0.45; med 0.30]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.46 mm [min 0.20; max 0.95; med 0.43]</td></tr><tr><td>Pedicle length</td><td colspan="2">22.7 mm [min 15; max 32; med 24]</td></tr><tr><td>Average vessel origin position</td><td>L (-27 ; -31)</td><td>R (24 ; -28)</td></tr><tr><td>Average position to the skin</td><td>L (-22 ; -33)</td><td>R (18; -28)</td></tr></table>

DCI summary

<table><tr><td>Source vessel</td><td colspan="2">Lateral thoracic artery</td></tr><tr><td>Artery diameter</td><td colspan="2">0.39 mm [min 0.25; max 0.55; med 0.40]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.64 mm [min 0.35; max 0.90; med 0.68]</td></tr><tr><td>Pedicle length</td><td colspan="2">28.3 mm [min 20; max 40; med 27]</td></tr><tr><td>Average vessel origin position</td><td>L (-10 ; 35)</td><td>R (-11 ; 34)</td></tr><tr><td>Average position to the skin</td><td>L (9 ; 26)</td><td>R (9 ; 24)</td></tr></table>

LT summary

<table><tr><td>Source vessel</td><td colspan="2">Femoral artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.35 mm [min 0.25; max 0.45; med 0.35]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.62 mm [min 0.45; max 0.80; med 0.60]</td></tr><tr><td>Pedicle length</td><td colspan="2">22.1 mm [min 18; max 26; med 22]</td></tr><tr><td>Average vessel origin position</td><td>L (20 ; -32)</td><td>R (-23 ; -30)</td></tr><tr><td>Average position to the skin</td><td>L (16 ; -24)</td><td>R (-17 ; -24)</td></tr></table>

SIE summary

<table><tr><td>Source vessel</td><td colspan="2">Internal thoracic artery and vein</td></tr><tr><td>Artery diameter</td><td colspan="2">0.29 mm [min 0.15; max 0.40; med 0.30]</td></tr><tr><td>Vein diameter</td><td colspan="2">0.39 mm [min 0.20; max 0.50; med 0.40]</td></tr><tr><td>Pedicle length</td><td colspan="2">35.25 mm [min 24; max 50; med 34.50]</td></tr><tr><td>Average vessel origin position P1</td><td>L (6 ; 19)</td><td>R (-6 ; 19)</td></tr><tr><td>Average vessel origin position P2</td><td>L (6 ; 27)</td><td>R (-7 ; 28)</td></tr><tr><td>Average position to the skin P1</td><td>L (9 ; 21)</td><td>R (-9 ; 23)</td></tr><tr><td>Average position to the skin P2</td><td>L (9 ; 32)</td><td>R (-15 ; 33)</td></tr></table>

CE summary

<caption>Table 1: Data summary for PT, PIC, DCI, LT, SIE, and CE vessels</caption>
**Legend of figures**

Fig.1: Orthonormal axes according to anatomical landmarks (top left: dorsal landmark common to PT, DCI, and PIC vessels; top middle and top right: lateral landmark left and right for LT vessels; bottom left: a landmark for SIE vessels; bottom right: a landmark for CE vessels)

Fig.2: Cutaneous projection of the origin of the vessels (black) and their arrival on the skin (red) for a) PT b) DCI c) PIC d) LT e) SIE f) CE vessels

Fig.3:

a) left: a cloud of points (black: the birth of vessels, red: arrival at the skin, cross: average points) for PT

right: ellipses showing the average area of interest around the points with the most spaced coordinates) for PT

b) left: a cloud of points for DCI

right: ellipses for DCI
c) left: a cloud of points for PIC

right: ellipses for PIC
d) Summary of the average coordinates of the back reference frame, from top to bottom: PIC, DCI, PTP vessels

Fig.4:

a) left: a cloud of points (black: the birth of vessels, red: arrival at the skin, cross: average points) for LT's right side

right: a cloud of points (black: the birth of vessels, red: arrival at the skin, cross: average points) for LT left side

b) left: ellipses showing the average area of interest around the points with the most spaced coordinates) for LT's right side
**Legend of figures**

Fig.1: Orthonormal axes according to anatomical landmarks (top left: dorsal landmark common to PT, DCI, and PIC vessels; top middle and top right: lateral landmark left and right for LT vessels; bottom left: a landmark for SIE vessels; bottom right: a landmark for CE vessels)

Fig.2: Cutaneous projection of the origin of the vessels (black) and their arrival on the skin (red) for a) PT b) DCI c) PIC d) LT e) SIE f) CE vessels

Fig.3:

a) left: a cloud of points (black: the birth of vessels, red: arrival at the skin, cross: average points) for PT

right: ellipses showing the average area of interest around the points with the most spaced coordinates) for PT

b) left: a cloud of points for DCI

right: ellipses for DCI
c) left: a cloud of points for PIC

right: ellipses for PIC
d) Summary of the average coordinates of the back reference frame, from top to bottom: PIC, DCI, PTP vessels

Fig.4:

a) left: a cloud of points (black: the birth of vessels, red: arrival at the skin, cross: average points) for LT's right side

right: a cloud of points (black: the birth of vessels, red: arrival at the skin, cross: average points) for LT left side

b) left: ellipses showing the average area of interest around the points with the most spaced coordinates) for LT's right side
right: ellipses showing the average area of interest around the points
with the most spaced coordinates) for LT's left side

c) left: a cloud of points for SIE
right: ellipses for SIE

d) Left: a cloud of points (black: the birth of P1 vessels, blue: the birth of P2 vessels, green: arrival at P1 skin, orange: arrival at P2 skin, cross: middle points) for CE perforators

Middle: Paths of the perforators schematized between the middle points

Right: Ellipses showing the average area of interest around the points
with the most spaced coordinates.

<caption>Table 1: Data summary for PT, PIC, DCI, LT, SIE, and CE vessels</caption>
right: ellipses showing the average area of interest around the points
with the most spaced coordinates) for LT's left side

c) left: a cloud of points for SIE
right: ellipses for SIE

d) Left: a cloud of points (black: the birth of P1 vessels, blue: the birth of P2 vessels, green: arrival at P1 skin, orange: arrival at P2 skin, cross: middle points) for CE perforators

Middle: Paths of the perforators schematized between the middle points

Right: Ellipses showing the average area of interest around the points
with the most spaced coordinates.

Table 1: Data summary for PT, PIC, DCI, LT, SIE, and CE vessels
<figure><img src="image_1.png" /></figure>

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a

<figure><img src="image_9.png" /></figure>

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b

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c

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d

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a

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b

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c

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d

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<figure><img src="image_24.png" /></figure>
<figure><img src="image_23.png" /><figcaption>b</figcaption></figure>

<figure><img src="image_24.png" /><figcaption>c</figcaption></figure>

<figure><img src="image_25.png" /><figcaption>d</figcaption></figure>

<figure><img src="image_26.png" /></figure>
<figure><img src="image_25.png" /><figcaption>b</figcaption></figure>

<figure><img src="image_26.png" /><figcaption>c</figcaption></figure>

<figure><img src="image_27.png" /><figcaption>d</figcaption></figure>

<figure><img src="image_28.png" /></figure>