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.

Use of virtual surgical planning allows for complex maxillofacial reconstruction with multiple simultaneous free flaps to be performed reliably and successfully. The use of prefabricated jigs and precontoured plates eases osteocutaneous flap molding and inset, allowing for a more complex procedure to be successful.

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The reverse sural adipofascial flap (RSAF) is used to reconstruct challenging wounds of the foot and ankle. It offers several advantages over the traditional reverse sural flap, including less venous congestion. To complete the reconstruction, split-thickness skin grafting (STSG) may be done immediately or in a delayed fashion; however, both scenarios result in suboptimal take rates and prolonged healing. An acellular dermal matrix (ADM; Integra; Ethicon Inc, Somerville, New Jersey) and negative-pressure wound therapy (NPWT) combined with RSAF followed by delayed STSG may decrease wound healing time.In this study, 8 patients underwent reconstruction of lower-extremity wounds with RSAF. Four patients underwent RSAF with immediate STSG, and 4 underwent RSAF with placement of the ADM and a vacuum-assisted closure device, with STSG at a later date.The 4 patients who underwent RSAF and immediate STSG had an average time to heal of 141.2 days, and 2 patients required reoperation. The 4 patients who underwent RSAF with an ADM and NPWT had an average time to heal of 104.5 days, and 1 patient required reoperation. Average time until STSG was 41.5 days. The latter group demonstrated a reduction in time to heal by an average of 36.7 days, or 25%. All 8 patients achieved successful wound closure.The RSAF is a durable option for complex lower-extremity reconstruction. Interim placement of ADM and NPWT may increase STSG take rates. Using this technique in conjunction with RSAF may decrease the overall healing time compared with RSAF with immediate STSG.