Background 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. Methods 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. Results 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). Conclusions The study findings indicate that the PAP flap, when compared with the TUG flap, could be a better secondary option for breast reconstructions.
Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.
BackgroundMaintaining stability and restoring the aesthetic appearance are the fundamental goals when managing zygomatic fractures. We aimed to evaluate the stability and anthropometric outcomes of zygomatic fracture patients who underwent two-point fixation involving the infraorbital rim and zygomaticomaxillary buttress via the transconjunctival and gingivobuccal approaches without any skin incisions.MethodsWe examined 15 zygomatic fracture patients who underwent two-point fixation during a 3-year period. Stability was evaluated using three-dimensional facial bone computed tomography. Superoinferior and anteroposterior displacement of the zygoma was quantified. The aesthetic appearance of the periorbital region was evaluated using indirect anthropometry with standardized clinical photographs. The ratios between the eye fissure height and width, and lower iris coverage ratio were used to evaluate aesthetical changes. The bony displacement and aesthetic ratios were analyzed using Wilcoxon or Friedman tests. The correlation between the preoperative zygoma position and anthropometric values was analyzed.ResultsThe positions of the zygoma were similar to those on the contralateral side at the long-term follow-up. The preoperative anthropometric measurements on the fractured side differed from those on the contralateral side, although these values were close to the normal values at the long-term follow-up. Furthermore, we noted that the anteroposterior displacement strongly positively correlated with the lower iris coverage rate (Spearman's coefficient= 0.678, P=0.005).ConclusionsTwo-point fixation of zygomatic fractures achieved stable outcomes on long-term follow-up, and also appeared to be reliable in restoring the aesthetic appearance of the periorbital region.
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