Breast Reconstruction with the Profunda Artery Perforator Flap

Allen, Robert J.; Haddock, Nicholas T.; Ahn, Christina Y.; Sadeghi, Alireza

doi:10.1097/prs.0b013e3182363d9f

Cited by 249 publications

(249 citation statements)

References 8 publications

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“…The PAP offers improved donor-site aesthetics and pedicle length, and an easier dissection relative to other secondary options such as the superior gluteal artery perforator or inferior gluteal artery perforator flaps. 3,5,6,9 For the patient presented here undergoing bilateral autologous reconstruction of large breasts, stacked DIEP/PAP flaps would have been the preferred technique, but with the abdominal donor site unavailable the fleur-de-lis modification of the PAP flap offered an acceptable secondary option.…”

Section: Discussionmentioning

confidence: 99%

“…2,8 The number of reliable perforator flap options available for breast reconstruction has also increased over this period of time, allowing for greater surgical flexibility and creativity. 3,4 The DIEP flap remains the perforator flap of choice in most patients. When the abdominal donor site is not available, or contains insufficient donor tissue for an adequate reconstruction, alternative approaches must be considered.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The ability to harvest the PAP flap in the lithotomy position makes it amendable to a simultaneous two-team approach-increasing operative efficiency-and the perforasome anatomy permits variation in skin paddle design-with either transverse PAP (tPAP) or vertical PAP (vPAP) flaps available-allowing a "designer" approach based on each patient's unique anatomy. 6 We present the first described case of an immediate bilateral autologous breast reconstruction using the "fleurde-PAP" (FDP) flap design-incorporating tissue from both the tPAP and vPAP skin paddles on a single vascular pedicle.…”

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Untitled

2017

J Reconstr Microsurg Open

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).Perforator flaps have become accepted as an excellent option for autologous breast reconstruction. The deep inferior epigastric perforator (DIEP) flap is the first-line option for perforator-based flaps in most patients due to the available tissue volume, skin quality, and secondary aesthetic benefits. 1,2 However, variability in patient anatomy and body habitus create the need for reliable secondary flap options.While several perforator flaps have been used successfully for patients in whom the abdominal donor site is not available, the profunda artery perforator (PAP) flap has emerged in recent years as a popular choice due to its ease of dissection and favorable donor-site aesthetics. 3-5 The ability to harvest the PAP flap in the lithotomy position makes it amendable to a simultaneous two-team approach-increasing operative efficiency-and the perforasome anatomy permits variation in skin paddle design-with either transverse PAP (tPAP) or vertical PAP (vPAP) flaps available-allowing a "designer" approach based on each patient's unique anatomy. 6 We present the first described case of an immediate bilateral autologous breast reconstruction using the "fleurde-PAP" (FDP) flap design-incorporating tissue from both the tPAP and vPAP skin paddles on a single vascular pedicle. Clinical ReportA 42-year-old female patient was referred to our clinic with a diagnosis of unilateral multifocal ductal carcinoma in situ, a plan for bilateral mastectomies, and a desire for autologous reconstruction. On examination the patient demonstrated large, ptotic breasts, and a lower abdominal scar from a previous abdominoplasty (►Fig. 1). Computed tomography angiography was obtained to evaluate perforator anatomy for free tissue transfer from the patient's thighs. To account for the volume of tissue required and the bilateral nature of the reconstruction, flaps were designed that incorporated both the tPAP and vPAP territories in a "fleur-de-lis" pattern.With the patient in the lithotomy position, two perforators were marked out along the vertical axis of each flap, and the transverse limbs were extended from the centrally positioned vertical skin paddle to complete the markings (►Fig. 2). The dissection began using an anterior approach, and was carried through the subcutaneous tissue and muscular fascia of the gracilis and adductor magnus muscles until the perforators were visualized. The vascular pedicle was divided at its origin to obtain sufficient length and caliber, and the harvest of the Keywords ► autologous breast reconstruction ► profunda artery perforator ► stacked flaps AbstractThe authors present the case of a 42-year-old female patient who underwent autologous breast reconstruction using a new perforator flap designed from the medial and posterior thigh. Due to a prior abdominoplasty, the patient's abdominal donor site was unavailable to reconstruct her large, ptotic breasts, so an alternate approach was undertaken. The fleur-de-PAP flap is based on the same perforators employed by the standard profunda artery perforato...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Untitled

2017

J Reconstr Microsurg Open

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“…Celles-ci seraient de plus gros calibre que les perforantes issues de l'artère circonflexe fémorale médiale, passant à travers le muscle gracilis. Allen et al [9] ont décrit pour la première fois en 2012 une nouvelle technique de reconstruction mammaire, le profunda artery perforator (PAP) flap, qui repose sur ces perforantes issues des vaisseaux fémoraux profonds, avec une série de 27 patientes. Cette technique a été reprise par Satake et al [10] en 2014, avec une série de 70 patientes.…”

Section: Introductionunclassified

Reconstruction mammaire par profunda artery perforator flap : étude prospective des 30 premiers cas consécutifs

Haddad¹,

Hunsinger²,

Obadia³

et al. 2016

Annales de Chirurgie Plastique Esthétique

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“…Dissection can be carried out in a supine frog leg position although is technically easier prone. The wound is closed in layers to blend with the gluteal fold and should not affect gluteal contour [19].…”

Section: Thigh Based Flapsmentioning

confidence: 99%

Flap-based breast reconstructions

Bartlett

Kołacińska

Spiegel

2017

Nowotwory. Journal of Oncology

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Breast cancer reconstruction is generally broken down into two major categories: Implant based and autologous. Both can provide excellent aesthetic results in the well selected patient although the decision ultimately comes down to the patient under the guidance of a reconstructive plastic surgeon. Implant based reconstruction is beyond the scope of this text, rather we will discuss autologous based reconstructive options. Broadly classified, tissue based reconstruction can be categorized as local or free tissue transfer. The general theme is the use of excess or expendable tissue in order to reconstruct breast defects. Studies have shown women are more satisfied with autologous based reconstruction compared to implanted based [1]. In this chapter we will discuss different tissue flap options in the reconstructive plastic surgeons armamentarium, special considerations and how it relates to the oncologic breast surgeon.

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Breast Reconstruction with the Profunda Artery Perforator Flap

Abstract: Therapeutic, V.

Cited by 249 publications

References 8 publications

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Untitled

Reconstruction mammaire par profunda artery perforator flap : étude prospective des 30 premiers cas consécutifs

Flap-based breast reconstructions

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