Profunda Femoris Artery Perforator Flap Research Articles

Patient-reported and surgical outcomes of profunda artery perforator (PAP) flap breast reconstructions compared to deep inferior epigastric perforator (DIEP) using BREAST-Q

BackgroundAutologous breast reconstruction patients require thorough assessment, with the profunda femoris artery perforator flap (PAP) having become an important autologous reconstruction option alongside the deep inferior epigastric perforator flap (DIEP). Breast reconstruction impacts patients psychologically, physically and mentally. The BREAST-Q aids to assess patient reported outcomes measures (PROMs). We aim to critically compare post-operative clinical outcomes, aesthetic results, morbidity and patient satisfaction between DIEP and PAP patients, using clinical follow-up and PROMs. MethodsA non-blinded two-armed prospective cohort study was performed. Patients undergoing PAP or DIEP reconstructions between January 2021 and February 2022 were included and followed up for at least one year post-operatively. Demographic and per-operative data was acquired. Breast-Q data was collected pre-operatively, and at 2-week, 3-month and 1-year intervals post-operatively. Results157 patients had autologous breast reconstruction (207 flaps), with 129 (82.1%) DIEP patients and 21 (13.3%) PAP patients. 37 (28.6%) patients underwent bilateral DIEP reconstructions and 1 (5%) PAP case was bilateral. Remaining PAP cases were stacked flaps for unilateral breast reconstruction. Mean ischaemia time for PAP was 55.29 (+/- 15.59minutes) compared to 69.52 (+/- 21.74minutes) for DIEP (p=0.014). Donor site wound dehiscence was significantly higher with PAP reconstructions (p=0.014). ConclusionsAt one year follow-up, no significant differences in PROMs across all domains between DIEP and PAP flap reconstructions were noted. This reflects that PAP flaps, despite having a more challenging donor site and higher donor site complications, provide an excellent reconstructive option with similar patient-reported outcomes when compared to the gold-standard DIEP flap reconstruction.

The profunda artery perforators: Anatomical study and radiological findings using computed tomography angiography in patients undergoing PAP flap breast reconstruction

The popularity of the profunda femoris artery perforator (PAP) flap is increasing; however, knowledge concerning the standardization of radiological findings and their clinical implications is limited. We evaluated the radiological architecture of posterior thigh perforators using Computed Tomography Angiography (CTA) to identify landmarks to facilitate flap dissection. A retrospective study was conducted on 35 patients who underwent unilateral breast reconstruction with a PAP flap. The preoperative CTA scans were analyzed, and the perforator characteristics were evaluated. The perforators were mapped using a Cartesian coordinate system. Data were normalized by anatomical landmarks and overlapped. Perioperative and postoperative results were analyzed. Radiological and intraoperative were compared. Two CTA scans were excluded; 66 thighs were examined. The mean perforator number was 3.2. The mean diameter of chosen perforators was 2.7mm (DS±0.6mm) at the origin, 2.2mm (DS±0.4mm) at the adductor space midpoint, and 1.7mm (DS±0.3mm) at the deep fascia. The mean adipose tissue thickness was 3.35cm (DS±0.94) at the deep fascia and 3.59cm (DS±1.19) at the adductor space midpoint. Intraoperatively, the perforator was located 3.22cm (DS±0.87) from the posterior border of the gracilis muscle and 8.98cm (DS±1.44) from the inferior gluteal crease. A radiological area located 9.33cm (DS±4.81) from the y-axis and 7.48cm (DS±1.88) from the x-axis was identified. CTA using the volume-rendering technique is a valuable method to study in vivo the radiological anatomy of the posterior thigh perforators.

Filling the Upper Pole with the Pectoralis Major Muscle Flap in Profunda Femoris Artery Perforator Flap Breast Reconstruction.

Background and Objectives: Among many donor site options for autologous breast reconstruction, the use of the profunda femoris artery perforator (PAP) flap has become common in patients who are not suitable for the gold standard procedure, the deep inferior epigastric artery perforator flap. However, its limited volume has precluded its wide use in breast reconstruction. The aim of this report was to demonstrate the effectiveness of a method in which the anatomical position of the pectoralis major muscle was adjusted to augment the volume of the superior pole of the breast during PAP flap transfer. A comparison was made with a conventional PAP flap breast reconstruction. Materials and Methods: Fifty-nine consecutive cases where unilateral autologous breast reconstruction was performed using the vertically designed PAP flap were retrospectively reviewed. Conventional PAP flap transfer was performed in 36 patients (Group 1), and PAP flap transfer with pectoralis major muscle augmentation was performed in 23 patients (Group 2). Results: The patient satisfaction at 12 months postoperatively was statistically greater in Group 2, with the pectoralis major muscle augmentation, than in Group 1 [23/36 (64%) vs. 22/23 (96%), p = 0.005]. There were no significant differences in postoperative complication rates at the reconstructed site [2/36 (5.6%) vs. 0/23 (0%), p = 0.52]. Conclusions: Higher patient satisfaction could be achieved with pectoralis major muscle augmentation in PAP flap breast reconstruction without increasing the postoperative complication rate at the reconstructed site.

Use of the Profunda Femoris Artery Perforator Flap for Reconstruction after Sarcoma Resection.

Background:Soft tissue sarcomas are rare neoplasms that can occur on any part of the body. The operative position for the resection is determined depending on the site of the soft tissue sarcomas; intraoperative repositioning may be needed for reconstruction. We present the profunda femoris artery perforator (PAP) flap harvest technique (wherein the flap can be used in any position), and suggest that the PAP flap transfer can eliminate the need for intraoperative repositioning.Methods:From December 2018 to January 2020, 7 patients with an average age of 68 years underwent reconstructions using a PAP flap after wide resection of STS. The mean defect size was 11.3 × 16.5 cm (range, 5.5–25 × 11–26 cm). The location of the defects was the medial thigh in 2 patients, the posterior thigh in 1, the popliteal fossa in 1, the groin in 1, and the buttock in 2. The PAP flap was elevated in the supine “frog-leg” position, the prone position, the jack-knife position, or the lateral “crisscross” position; the lateral decubitus position with the donor lower extremity on the bottom.Results:Of the 7 cases, the operations were performed in the supine “frog-leg” position in 3 cases, the prone position in 2 cases, the jack-knife position in 1 case, and the lateral “crisscross” position in 1 case. There were no intraoperative position changes in all cases. The mean size of the PAP flap was 8.7 × 19.9 cm (range, 6–11 × 17–24 cm). One patient had donor site dehiscence, which was treated conservatively. The PAP flaps survived completely in all cases. The mean follow-up period was 10.5 months (range, 6–17 months).Conclusion:Since the PAP flap elevation is feasible in every position, the PAP flap can be considered a versatile reconstruction option after sarcoma resection.

Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review.

Thigh-based flaps are generally considered a secondary option for breast reconstruction, with inner thigh-based transverse upper gracilis (TUG) flaps being the preferred choice for many surgeons; however, its well-established drawbacks include short pedicle length, lack of volume, and donor morbidity. The posterior thigh-based profunda femoris artery perforator (PAP) flap was introduced as an alternative approach, but these flaps were not comparatively analyzed with TUG flaps on a large scale. We aimed to systematically review TUG- and PAP-flap breast reconstruction to determine the better secondary option. We performed a systematic review of the literature using the PubMed database. Our selected series for systematic analyses included 613 TUG flaps in 432 patients and 475 PAP flaps in 329 patients. Elementary data on the flaps and complications were collected and analyzed. Pooled estimates of proportions of flaps with recipient complications and donor site morbidity were compared using random effect single arm meta-analysis. The basic patient demographics were comparable between the flap types. The mean operation time was comparable. The PAP flap had longer pedicle length and higher flap weight. The total loss (p = .6579), partial loss rate (p = .3247), and fat necrosis rate (p = .0771) were comparable between flap types. Regarding donor morbidity, the PAP flap group had less wound dehiscence (p < .0001) and lower rate of sensory disturbance (p < .0001). The study findings indicate that the PAP flap, when compared with the TUG flap, could be a better secondary option for breast reconstructions.

An anatomical study of the lymph-collecting vessels of the medial thigh and clinical applications of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative indocyanine green (ICG) lymphography

The profunda femoris artery perforator (PAP) flap is gaining popularity in microsurgical reconstruction. The complications that can occur after the PAP flap harvest include donor-site lymphedema, seroma, or cellulitis. The aim of this study was to evaluate and establish a safer technique for the elevation of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative ICG lymphography. In this article, we also evaluate the anatomical relationship between the PAP flap and lymph-collecting vessels. From July of 2018 to January of 2019, 24 patients with soft tissue defects after tumor resection underwent reconstruction using PAP flaps. The lymph-collecting vessels at the medial thigh area were identified using pre- and intraoperative ICG lymphography. A PAP flap was elevated taking care not to damage lymph-collecting vessels. After flap elevation, the anatomical correlation between lymph-collecting vessels and the anterior edge of the gracilis muscle was measured. The postoperative complications were assessed. PAP flaps survived completely in all cases. In all cases, using intraoperative ICG lymphography, surgeons confirmed that the lymph-collecting vessels in the medial thigh region were left intact. There were no donor site complications such as lymphedema, lymphorrhea, or cellulitis. The elevation technique of an LpPAP flap is effective in reducing the risk of damage to lymph-collecting vessels, and thus reducing chances of postoperative lymphorrhea or iatrogenic lower limb lymphedema.

Free profunda femoris artery perforator flap as a first-line choice of reconstruction for partial glossectomy defects.

Free profunda artery perforator (PAP) flap has recently been brought back for head and neck reconstruction. During the course of 1 year, we performed this procedure for reconstruction of partial glossectomy defects with excellent results. From January through December 2015, 21 patients underwent partial glossectomy reconstruction with PAP flaps. Demographics, surgical technique, anatomic variations, success rates, complications, and characteristics are described. Swallowing and speech results after reconstruction are evaluated. No donor-site complications were observed. Two cases presented complications potentially related to the flap (1 hematoma and 1 prolonged intubation) that were treated successfully. Deglutition and speech assessment resulted in fair to excellent swallowing capacity in all patients. Speech score resulted 4/5 to 5/5 in all patients at 3-month follow-up. The PAP flap should be considered one of the first-line options for hemiglossectomy reconstruction, receiving special consideration in the high-risk population in which future complex reconstructions could be needed. © 2016 Wiley Periodicals, Inc. Head Neck 39: 737-743, 2017.

Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps.

BackgroundReconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores.MethodsWe retrospectively analyzed data from 14 patients (16 ischial sores) whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course.ResultsAll flaps survived the entire follow-up period. Seven patients (50%) had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years). The mean follow-up period was 27.9 months (range, 3-57 months). In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%), wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%), but resolved with conservative treatment. Among 16 cases, there was only one (6%) recurrence at 34 months.ConclusionsThe combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores.

The Anatomic Basis of the Profunda Femoris Artery Perforator Flap: A New Option for Autologous Breast Reconstruction—A Cadaveric and Computer Tomography Angiogram Study

We propose the profunda femoris artery perforator (PAP) flap for autologous breast reconstruction. We provide an anatomic basis for this flap. Ten cadaveric thighs were dissected. A perforator was dissected to its origin. The lengths of pedicle, vessel diameters, and weights were measured. The average distance inferior to the gluteal crease was 3.5 cm (1 to 5 cm). The average distance from the midline was 6.2 cm (3 to 12 cm). The average pedicle length was 10.6 cm. Diameters of the artery and vein averaged 2.3 mm and 2.8 mm. The flaps averaged 28 × 8 cm. The average weight was 206 g (100 to 260 g). Computed tomography angiograms of 20 thighs were examined. Measurements were taken from the gluteal crease and midline to the perforator. The average distance caudal to the gluteal crease was 4.4 cm (1.1 to 7.2 cm). The average distance lateral to the midline was 5.1 cm (2.5 to 9 cm). The data presented in this article provide an anatomic basis for the PAP flap.