Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Abstract

Soft tissue microsurgical reconstruction in the head and neck regions can be performed with different types of free flaps. For decades, the anterolateral and anteromedial thigh regions have been considered as the ideal donor sites [1,2], especially in Asian countries. Recently, the profunda artery perforator (PAP) flap harvested from the posteromedial region of the thigh has been proposed as a good choice for use in oral cavity reconstruction [3,4,5]. However, in the Western countries, thigh flaps, especially the PAP flaps, are not used as often as in the Asian countries for oral reconstruction because there are concerns regarding the greater thickness of thigh flaps as compared with the radial forearm free flaps (RFFF). There are previous publications on anterolateral thigh (ALT) flap thickness measured with Doppler ultrasound [6,7] and only one study using computed tomographic angiography (CTA) [8]. However, none of these studies compare ALT flap thickness with PAP flap thickness in the same patient. The aim of this study was to compare the PAP flap thickness with the thickness of other thigh flaps that were more commonly used for intraoral reconstruction and to identify the factors influencing its thickness in our population using CTA. This information would be useful to facilitate flap selection based on desired tissue volume in patients with greater thigh thickness, like our population. MATERIAL AND METHODS Study Sample The study sample comprised 72 legs of 36 patients. The inclusion criteria were the patients who underwent head and neck microsurgical reconstruction with a fibula free flap and a preoperative CTA. The exclusion criteria consisted of the antecedent of previous thigh flap harvested. CTA was performed on a 64-slice multiple detector computed tomography scanner (LightSpeed VCT; GE Healthcare, Milwaukee, WI, USA) using a standardized protocol. Data post-processing was done using the open-source software Horos TM v 1.1.7 (GNU Lesser General Public License, version 3). Morphologic analysis of flap thickness and perforator location was done for the ALT flap, the anteromedial (AMT) flap, the distal superficial femoral artery perforator (d-SFAP) flap, and the PAP flap in all 72 legs. The d-SFAP flap is not commonly used for intraoral reconstruction, but it was also included in this study because of the constancy of the location of its perforator. For the ALT flap, the references were the anterior superior iliac spine (ASIS) and the superolateral border of the patella. The best perforator around the midpoint between both references was identified and its location relative to the ASIS was registered. The same references were used for the AMT flap. The cutaneous perforator of the AMT flap was located close to the intersection between the rectus femoris and sartorius muscles. The perforator's location (relative to the ASIS) and its origin-whether arising from the lateral circumflex femoral artery (LCFA), medial circumflex femoral artery (MCFA), or superficial femoral artery (SFA)-were identified. For the P...

Chimeric profunda artery perforator ‐ gracilis flap: A computed tomographic angiography study and case report

“…Preoperative CTA has been previously validated as an adequate technique for morphological analysis of the PAP flap (DeLong et al, 2014; Haddock et al, 2012; Heredero et al, 2019; Saad et al, 2012; Wong et al, 2015). In this study, we used CTA to further understand the relationship between the gracilis muscle pedicle and the perforators of the PAP flap.…”