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

Abstract

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.

Keywords

breast reconstruction - DIEP - PAP flap - profunda femoris artery perforator flap - perforator flap

• References

• 1 Yueh JH, Slavin SA, Adesiyun T , et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 2010; 125: 1585-1595
• 2 Damen TH, Timman R, Kunst EH , et al. High satisfaction rates in women after DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg 2010; 63: 93-100
• 3 Visser NJ, Damen TH, Timman R, Hofer SO, Mureau MA. Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction. Plast Reconstr Surg 2010; 126: 26-36
• 4 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32: 32-38
• 5 Yousif NJ. The transverse gracilis musculocutaneous flap. Ann Plast Surg 1993; 31: 382
• 6 Wechselberger G, Schoeller T, Bauer T , et al. Surgical technique and clinical application of the transverse gracilismyocutaneous free flap. Br J Plast Surg 2001; 54: 423-427
• 7 Allen RJ, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 1995; 95: 1207-1212
• 8 LoTempio MM, Allen RJ. Breast reconstruction with SGAP and IGAP flaps. Plast Reconstr Surg 2010; 126: 393-401
• 9 Nahabedian MY. Bilateral autogenous breast reconstruction using perforator free flaps: a single center's experience. Plast Reconstr Surg 2004; 114: 90-92
• 10 Scheufler O, Farhadi J, Kovach SJ , et al. Anatomical basis and clinical application of the infragluteal perforator flap. Plast Reconstr Surg 2006; 118: 1389-1400
• 11 Ahmadzadeh R, Bergeron L, Tang M, Morris SF. The superior and inferior gluteal artery perforator flaps. Plast Reconstr Surg 2007; 120: 1551-1556
• 12 Schaverien M, Saint-Cyr M, Arbique G, Brown SA. Arterial and venous anatomies of the deep inferior epigastric perforator and superficial inferior epigastric artery flaps. Plast Reconstr Surg 2008; 121: 1909-1919
• 13 Blondeel N, Vanderstraeten GG, Monstrey SJ , et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 1997; 50: 322-330
• 14 Nahabedian MY, Manson PN. Contour abnormalities of the abdomen after transverse rectus abdominis muscle flap breast reconstruction: a multifactorial analysis. Plast Reconstr Surg 2002; 109: 81-87 ; discussion 88–90
• 15 Futter CM, Webster MHC, Hagen S, Mitchell SL. A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap. Br J Plast Surg 2000; 53: 578-583
• 16 Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg 2004; 114: 69-73
• 17 Ahmadzadeh R, Bergeron L, Tang M, Geddes CR, Morris SF. The posterior thigh perforator flap or profunda femoris artery perforator flap. Plast Reconstr Surg 2007; 119: 194-200 ; discussion 201–202
• 18 Kanchwala SK, Glatt BS, Conant EF, Bucky LP. Autologous fat grafting to the reconstructed breast: the management of acquired contour deformities. Plast Reconstr Surg 2009; 124: 409-418
• 19 Allen RJ. Discussion: trials and tribulations with the inferior gluteal artery perforator flap in autologous breast reconstruction. Plast Reconstr Surg 2011; 128: 625e