Comments on “comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review”

Background The volume of the profunda femoris artery perforator (PAP) flap limits its indications to small- and medium-sized breast reconstructions after modified radical mastectomy for cancer. We report a modified PAP flap design, including not only a vertical extension that increases its volume but also the skin surface, which suits larger breasts requiring immediate or delayed breast reconstructions and compare the results with our horizontal skin paddle PAP flap experience. Patients and Methods In our center between November 2014 and November 2016, 51 consecutive patients underwent a PAP flap breast reconstruction following breast cancer. A retrospective analysis on the collected data was performed to compare 34 patients with a bra cup smaller than C who underwent 41 horizontal PAP flap procedures, with those (n = 17) of a bra cup greater than or equal to C who underwent 21 fleur-de-lys PAP flap procedures. Demographic, anthropometric, flap and surgical characteristics, postoperative complication rates, and hospital stay were compared between the two groups. Results The average flap weight was 480 g (range: 340–735 g) for the fleur-de-lys PAP flap group compared with 222 g (range: 187–325 g) for the horizontal PAP flap procedure (p < 0.001). The mean flap dimensions were 25 × 18 cm for the fleur-de-lys PAP flap group compared with 25 × 7 cm in the horizontal PAP flap group. No flap failure was observed in the fleur-de-lys PAP flap group compared with two flap failures secondary to venous thrombosis in the horizontal PAP flap group (NS). Three patients (14%) experienced delayed healing at the donor site compared with four patients (10%) in the horizontal PAP flap group (NS). Conclusion The fleur-de-lys skin paddle design not only allows an increase of the horizontal PAP flap volume, but also increases the skin surface, with an acceptable donor site morbidity. For medium- or large-sized breasts, the fleur-de-lys PAP flap seems to be ideal when a DIEP flap-based reconstruction is contraindicated.

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

Journal of Reconstructive Microsurgery ◽

10.1055/s-0032-1313773 ◽

2012 ◽

Cited By ~ 3

Author(s):

Adam Saad ◽

Alireza Sadeghi ◽

Robert Allen

Keyword(s):

Breast Reconstruction ◽

Computer Tomography ◽

Perforator Flap ◽

Autologous Breast Reconstruction ◽

Profunda Femoris Artery ◽

Anatomic Basis ◽

Artery Perforator ◽

Profunda Femoris

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The Anatomical Basis of the Profunda Femoris Artery Perforator (PAP) Flap: A New Option for Autologous Breast Reconstruction

Breast Reconstruction ◽

10.1007/978-3-319-18726-6_10 ◽

2016 ◽

pp. 129-135

Author(s):

Adam Saad ◽

Alireza Sadeghi

Keyword(s):

Breast Reconstruction ◽

Autologous Breast Reconstruction ◽

Profunda Femoris Artery ◽

Anatomical Basis ◽

Artery Perforator ◽

Profunda Femoris

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Treatment of Ischial Pressure Sores with Both Profunda Femoris Artery Perforator Flaps and Muscle Flaps

Archives of Plastic Surgery ◽

10.5999/aps.2014.41.4.387 ◽

2014 ◽

Vol 41 (4) ◽

pp. 387 ◽

Cited By ~ 7

Author(s):

Chae Min Kim ◽

In Sik Yun ◽

Dong Won Lee ◽

Dae Hyun Lew ◽

Dong Kyun Rah ◽

...

Keyword(s):

Pressure Sores ◽

Perforator Flaps ◽

Muscle Flaps ◽

Profunda Femoris Artery ◽

Artery Perforator ◽

Profunda Femoris

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Designing Lateral Thoracic Wall Perforator Flaps for Breast Reconstruction Using the Ultrasound

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740127 ◽

2021 ◽

Author(s):

Marzia Salgarello ◽

Giuseppe Visconti

Keyword(s):

Breast Reconstruction ◽

Duplex Ultrasound ◽

Free Flaps ◽

Thoracic Wall ◽

Perforator Flaps ◽

Thoracodorsal Artery ◽

The Us ◽

Latissimus Dorsi Myocutaneous Flap ◽

Artery Perforator ◽

Color Duplex Ultrasound

Abstract Background Lateral thoracic flaps represent a precious source for partial and total breast reconstruction, in some cases as first option and in other cases as alternative of free flaps. This article describes the ultrasound (US)-based planning of the lateral thoracic wall perforator adipocutaneous flaps and it reports our experience on 52 consecutive flaps. Patients and Methods From November 2018 to May 2021, 52 consecutive lateral thoracic wall perforator flaps were performed using the US-based method for reconstruction of partial breast defects and total breast reconstruction. High-frequency US was performed in all cases prior to surgery to select the best perforator and design the flap. Results Of the 52 cases, 41 were lateral intercostal artery perforator flaps (78.8%), and 11 were thoracodorsal artery perforator (TDAP) flaps. Of the 11 TDAP flaps, 2 cases were based on the direct cutaneous branch. Moreover, in two other cases clinically scheduled for lateral thoracic perforator flaps due to the presence of an appropriate axillary roll, no suitable local/regional perforators were detected with the preoperative US examination and the latissimus dorsi myocutaneous flap was performed. Conclusion Preoperative planning of these flaps using US speeds the surgery and makes it easier and more efficient. Therefore, it is reasonable that the color duplex ultrasound is the operative surgeon's tool for mapping the lateral thoracic wall perforators and to appropriately plan each flap.

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