Abstract
Background While the originally described transverse profunda artery perforator (tPAP) flap
is designed to capture the first profunda perforator, our group hypothesized the dominant
perforator may not always be captured in this configuration. This study maps the location
of dominant profunda perforators using imaging and cadaveric dissections to determine
the probability of capturing dominant perforators with the transverse flap design
versus the vertical PAP (vPAP) variant.
Methods Fifty preoperative magnetic resonance angiogram or computed tomographic angiogram
scans (100 total extremities) were examined from autologous breast reconstruction
patients between 2015 and 2019. Profunda perforator characteristics that were examined
included the distance from the pubic tubercle to the infragluteal fold (IGF), the
distance of the perforators from the IGF, distance posterior to the gracilis, the
diameter of the perforator at fascial exit, and total number of perforators present.
Profunda perforator dissection was performed in 18 cadaveric extremities. Analysis
included mean distance from pubic tubercle, distance posterior to the gracilis, diameter
at fascial exit, and total number of perforators.
Results In imaging analysis, the mean distance from the IGF to the fascial exit of all dominant
perforators was 7.04 cm. The mean diameter of the dominant perforator at the fascial
exit was 2.61 mm. Twenty-six thighs (26%) demonstrated dominant perforators that exited
the fascia greater than 8 cm below the IGF. In cadaver dissections, the mean distance
from the pubic tubercle to the fascial exit of all the dominant perforators was 10.17 cm.
Nine cadaver specimens (50%) demonstrated perforators that exited the fascia greater
than 8 cm below the estimated IGF.
Conclusion The dominant perforator can often be missed in the traditional tPAP design. The vPAP
incorporates multiple perforators with a long pedicle, excellent vessel diameter,
and favorable donor-site.
Keywords
microsurgery - perforator flap - profunda artery perforator flap
