Suprafascial radiological characteristics of the superthin profunda artery perforator flap

Abstract

Traditional subfascial harvest of the profunda artery perforator (PAP) flap results in a thick flap, which routinely requires secondary thinning. The aim of this study was to characterize the suprafascial perforator anatomy of PAPs on preoperative computed tomography angiography (CTA) and correlate radiological findings with our clinical experience in extremity reconstruction. Suprafascial PAP anatomy was reviewed in CTAs in 159 thighs. Findings on CTA were correlated with intraoperative findings in a cohort of patients who had a PAP flap for extremity reconstruction. Two main perforator patterns, a "T" (superficial bifurcation) and "Y" (deeper bifurcation) were identified. The ratio between the total skin thickness and the distance from the skin to the perforator bifurcation point and the total skin thickness was higher in the "T" perforator pattern. A dominant "T" perforator (n=97) was more common than "Y" (n=62). A dominant "T" perforator was more common in women and with higher body mass index (BMI). In the clinical study, we found a positive correlation between the skin thickness of the bifurcation point of a dominant "T" perforator and the thickness of the superficial fascia where a thin PAP flap is elevated. A dominant "T" perforator on preoperative CTA accurately predicts thickness of a PAP flap elevated at the level of the superficial fascia.