Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review

Abstract

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.

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

“…12 In addition to the advantage of performing a flap harvest in a supine position, the PAP flap is better than the TUG flap in terms of pedicle length and flap volume. 14,19,20 A PAP flap has much longer pedicle length, which is important in ptotic breast reconstruction for reducing thrombosis formation caused by inappropriate flap placement. Another big advantage of a PAP flap is the flap volume.…”

Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction

“…Alternative flap options include thigh-based flaps also used as stacked flaps, such as the posterior thigh-based PAP flap, the inner thigh-based transverse upper gracilis (TUG) flap, or the newly described TUGPAP, all presented as reliable with low morbidity and satisfactory cosmesis additionally to the first described tensor fasciae latae myocutaneous free flap [2, 18, 19]. In a recent systematic review of breast reconstruction with PAP, TUG, or TUGPAP flaps, TUG flaps had a significantly higher recipient and donor complication rate compared with both PAP and TUGPAP flaps, concluding that the TUGPAP flap is a safe and effective alternative.…”

“…Interestingly, in their analysis half of the flaps were anastomosed to anterograde/retrograde internal mammary vessels, whereas the rest used internal mammary/intraflap anastomoses. Notably, age, body mass index, flap weight, flap donor site, and recipient vessels were not linked to a higher flap complication risk [2, 18-20].…”

“…A question raised is which is the better secondary option for autologous breast reconstruction, as patient-reported satisfaction has not been presented as an outcome in the studies. In a systematic review comparing the TUG and profunda femoris artery perforator flaps, the PAP flap had longer pedicle length and higher flap weight, while regarding donor morbidity the PAP flap group presented less wound dehiscence and fewer sensory disturbance rates [18].…”

“…Notably, it is correlated with worst donor site morbidity, wound dehiscence, sensory deficit, and lymphedema. TUG flap-reconstructed breasts often require additional and more lipofilling procedures [18, 21, 23].…”