Estimation of Profunda Artery Perforator Flap Weight Using Preoperative Computed Tomography Angiography

Greige, Nicolas; Nash, David B.; Salibian, Ara A.; Sultan, Steven M.; Ricci, Joseph A.; Thanik, Vishal; Weichman, Katie E.

doi:10.1055/s-0040-1713599

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…However, more delicate and objective volumetric planning has been described in recent literature. 22 The median mastectomy weight of 11 stacked PAP flap reconstruction cases was 318.0 g, and the total sum of the initial PAP flap weight was 472.0 g, greatly exceeding the mastectomy weight. The total sum of the PAP flap weight was also greater than the average mastectomy weight in the conventional DIEP flap group.…”

Section: Discussionmentioning

confidence: 96%

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

Jeon

Han

2021

J Reconstr Microsurg

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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.

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Section: Discussionmentioning

confidence: 96%

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

Jeon

Han

2021

J Reconstr Microsurg

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“…By comparison, the profunda artery perforator (PAP) flap, which is elevated from the medial thigh as the donor site, is a skin flap that uses a perforating branch of the deep femoral artery as a feeding artery, and has recently been reported for use in breast reconstruction due to its ease of elevation and low invasiveness at the donor site (Allen et al, 2012; Dayan & Allen Jr, 2017; Haddock, Nagarkar, et al, 2017; Qian et al, 2019). The PAP flap uses fat tissue from the medial thigh and can be harvested with a limited weight compared with the DIEP flap (Greige et al, 2020). However, the PAP flap may instead be suitable for Japanese patients with low BMI, thin build, and relatively small breast size (Satake et al, 2014; Shibata et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…To address this issue, Greige et al developed a formula to predict the weight of a transversely designed PAP flap based on the following three measures on computed tomography angiography (CTA) images: fat thickness at 4.5 cm caudal to the gluteal crease, distance from the gluteal crease to the perforating branch, and body position during scanning (Greige et al, 2020). However, there has been no report of an estimation formula for the weight of the v‐PAP flap, which is considered to be more effective for reconstruction in patients with a thin build.…”

Section: Introductionmentioning

confidence: 99%

Preoperative estimation of vertical profunda artery perforator flap weight using computed tomography angiography for breast reconstruction

2023

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Background: The vertical profunda artery perforator (v-PAP) flap is limited in terms of the tissue volume that can be harvested but is a suitable graft for Japanese patients with relatively small breast sizes. The objectives of this study were to identify the parameter most closely correlated with v-PAP flap weight on computed tomography angiography (CTA) images and to create an easy-to-use v-PAP flap weight estimation formula by linear regression analysis using the identified parameter. Patients and Methods: Thirty v-PAP flaps in 25 patients who underwent breast reconstruction were retrospectively analyzed. Mean age was 46.1 (range: 32-73) years, and mean BMI was 20.0 (range: 15.3-23.6) kg/m 2 . On a CT horizontal section of the thigh taken at level of the center of the long axis of the flap, the following parameters were measured from the anterior margin of the gracilis muscle to the posterior margin of the semimembranosus muscle using image processing software: fat area, fat thickness, thigh circumference, and skin paddle area. Linear regression analysis was then performed with the weight of the harvested v-PAP flap as the objective variable and the above parameters as explanatory variables to predict skin flap weight. Results: Correlations with v-PAP flap weight of each parameter were as follows: r = 0.66 (p < .0001) for fat thickness, r = 0.32 (p = .081) for total thigh area, r = 0.36 (p = .054) for thigh circumference, r = 0.27 (p = .153) for skin paddle area, and r = 0.84 (p < .0001) for fat area. Thus, the fat area had the strongest correlation with v-PAP flap weight. The v-PAP flap weight estimation formula obtained by linear regression analysis including fat area was as follows: 7.3 Â fat area + 114 (coefficient of determination: R 2 = 0.70, p < .0001, RMSE = 24). The engraftment rate of the 30 v-PAP flaps was 100%. One patient developed postoperative venous thrombosis at the vascular anastomosis site, but underwent successful microsurgical revision, leading to flap salvage. During the >6-month follow-up period, there were no notable complications in the reconstructed breasts and donor sites.Conclusions: The v-PAP flap weight estimation formula we developed in this study showed a high correlation with measured values, allowing for easy estimation using only a single CTA horizontal section of the thigh.

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“…7,8 Meanwhile, profunda artery perforator (PAP) flaps, harvested from the medial thigh region with use of perforators branched from the deep femoral artery as feeding vessels, have been used for breast reconstruction in several recent studies because they are easy and less invasive to harvest. [9][10][11] The flap weight is more restricted for PAP flaps than commonly used DIEP flaps because of the availability of adipose tissue at the donor sites, 12 but PAP flaps are thought to be suited for use in slim Asian women with a low body mass index (BMI) and relatively small breasts. 13,14 However, in any free flap surgery, a skin paddle is exposed after immediate autologous breast reconstruction, and becomes a factor severely impairing the final appearance of the reconstructed breast after completion of nipple-areola complex (NAC) reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Minimal Scar Autologous Breast Reconstruction with Skin-sparing Mastectomy

Matsumine,

Niimi,

Jibiki

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: A skin paddle severely impairs the appearance of the reconstructed breast. We have established a new technique called “minimal scar autologous breast reconstruction” involving delayed nipple reconstruction using a local flap designed on the skin paddle and simultaneous resection of the residual skin paddle. Methods: We analyzed 20 patients with unilateral breast cancer who underwent skin-sparing mastectomy followed by immediate breast reconstruction using a free flap (deep inferior epigastric perforator flap in 13 patients and profunda artery perforator flap in seven). Approximately 1 year after primary reconstruction, nipple reconstruction using an arrow flap designed on the skin paddle and resection of the residual skin paddle were performed. Several months later, medical areola tattooing was performed. Bilateral breast symmetry scores, obtained from the distances between anatomic landmarks, were compared before and after breast reconstruction. Results: Postoperative complications such as necrosis of the reconstructed nipple were not observed after two-stage reconstruction, and all procedures including total resection of the skin paddle, nipple reconstruction, and medical tattooing were performed successfully in all cases. Aesthetic outcomes were excellent: comparison of symmetry scores showed no significant differences in any parameters between before surgery and after reconstruction of the nipple-areola complex. Conclusions: We have established step-by-step strategies for mastectomy, autologous breast reconstruction, and then nipple reconstruction, keeping in mind that the skin paddle would later be totally resected in nipple reconstruction, and thereby achieved breast reconstruction with markedly reduced postoperative scarring compared with conventional autologous breast reconstruction.

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Estimation of Profunda Artery Perforator Flap Weight Using Preoperative Computed Tomography Angiography

Cited by 6 publications

References 15 publications

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

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

Preoperative estimation of vertical profunda artery perforator flap weight using computed tomography angiography for breast reconstruction

Minimal Scar Autologous Breast Reconstruction with Skin-sparing Mastectomy

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