Medium- and Large-Sized Autologous Breast Reconstruction using a Fleur-de-lys Profunda Femoris Artery Perforator Flap Design: A Report Comparing Results with the Horizontal Profunda Femoris Artery Perforator Flap

Hunsinger, Vincent; Lhuaire, Martin; Haddad, Kevin; Wirz, Francesco-Saverio; Abedalthaqafi, Samah; Obadia, Déborah; Derder, M. E. M.; Marchac, Alexandre; Benjoar, Marc-David; Hivelin, Mikaël; Lantieri, Laurent

doi:10.1055/s-0038-1649508

Cited by 28 publications

(12 citation statements)

References 26 publications

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“…Among the 12 studies finally identified, 516 PAP flaps were included and their characteristics are shown in Table 1 [24, 27, 34–43]. They were all published in the past four years, four studies in the United States of America, three in France, three in China, and two, respectively, in the United Kingdom and the Netherlands.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

Qian

Xiong

et al. 2019

Journal of Oncology

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Background. The profunda artery perforator (PAP) flap was first applied in breast reconstruction in 2010 by Robert J. Allen. It provided an alternative for autologous breast reconstruction in addition to traditional donor sites. Currently, literature reporting its microsurgical safety and efficacy is relatively sparse and heterogeneous. Objective. To clarify the evidence regarding microsurgical safety and efficacy of PAP flap in breast reconstruction, which may contribute to future surgical decision-making. Methods. Multiple databases were systematically searched by two independent reviewers. The result was statistically analyzed with Meta command of R GUI 3.5.1. The proportions with 95% confidence intervals (CIs) were calculated by using random-effect model. Results. There were 12 studies including 516 PAP flaps meeting the inclusion criteria. The pooled surgical success rate was 99% (95% CI: 97%–100%) and overall rate of complications was 23% (95% CI: 18%–27%). The most common individual complication was wound dehiscence with incidence of 6% (95% CI: 4%–9%). The seroma rate was 2% (95%CI: 0%–6%). The hematoma rate was 1% (95% CI: 0%–2%). The partial necrosis rate was 2% (95% CI: 0%–5%). The rate of total flap loss was 1% (95% CI: 0%–3%). Conclusion. To date, this study is the first meta-analysis of microsurgical efficacy and safety evaluation of the PAP flap in breast reconstruction. This present work confirmed that the PAP flap is safe and reliable in breast reconstruction with high success rate, but a relatively low complication rate. Moreover, it might be more than an alternative to the deep inferior epigastric perforator flap (DIEP) in microsurgical breast reconstruction in selected patients.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

Qian

Xiong

et al. 2019

Journal of Oncology

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“…These studies have also established the limitations of the They reported a mean horizontal diameter of 16.7 cm and a mean vertical diameter of 16.5 cm. Since this report, modified and extended versions of the PAP flap have been reported, including vertical and fleur-de-lys designs (Bourn et al, 2019;Hunsinger et al, 2019;Rivera-Serrano, Aljaaly, Wu, & Cheng, 2017). The modifications even evolved to inverted-L design to meet the demand for required breast volumes (Scaglioni, Eder, & Giovanoli, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Studies not relevant (142 articles), cadaver or imaging studies (7 articles), case reports (5 articles), reviews (1 article), and reports in languages other than English (3 articles) were further excluded, resulting in 18 articles for full-text review. After excluding 10 articles lacking extractable data or with suspected cohort overlap, 8 articles were included in the systematic analysis (Figure 1b)(Allen Jr et al, 2016;Ciudad et al, 2016;Haddock, Gassman, Cho, & Teotia, 2017;Hunsinger et al, 2019;Hunter et al, 2015;Hupkens et al, 2016;Satake et al, 2014;Scaglioni, Chen, Lindenblatt, & Giovanoli, 2017…”

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confidence: 99%

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

Kim

Eom

et al. 2020

Microsurgery

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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.

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“…The main disadvantage of PAP flap reconstruction of the breast remains its relatively limited volume for large reconstructions, especially compared to the DIEP flap (12,29). Average DIEP flap volumes have been reported to be around 700 g, while PAP flap volumes average 220 to 405 g with the ability to expand to 480 g by modifying flap design (29)(30)(31)(32)(33). Augmenting with another flap, implant, or fat grafting represent additional potential workarounds to this drawback.…”

Section: Pap Flap: Advantages and Disadvantagesmentioning

confidence: 99%

Alternative donor sites in autologous breast reconstruction: a clinical practice review of the PAP flap

Lu¹,

Zhang²,

Graziano³

et al. 2023

Gland Surg

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Breast cancer is currently the most common cancer in female patients in the United States and around the world, with over 2 million new cases of breast cancer diagnosed in 2020. Subsequently, breast reconstruction after mastectomy is also becoming increasingly common. While not every patient elects to undergo reconstruction after mastectomy, many patients desire reconstruction with either implant-based or autologous tissue. In certain patients, autologous reconstruction can offer a multitude of advantages over implant-based reconstruction. While abdominally-based free flaps such as the deep inferior epigastric perforator (DIEP) flap have become the flap of choice for breast reconstruction, the profunda artery perforator (PAP) flap is a strong alternative for patients in which abdominally-based flaps are contraindicated or insufficient. This clinical practice review aims to summarizes the history of the PAP flap, describe relevant anatomy and characteristics of the PAP flap that make it a well-suited option in breast reconstruction. It will also provide clinical pearls related to pre-operative preparation, markings, and surgical technique involved in ensuring successful perforator dissection, flap harvest, inset, and survival. Finally, this review will discuss current literature published on PAP flaps to determine post-operative clinical outcomes, complications, and patient reported outcomes associated with PAP flap breast reconstruction.

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Medium- and Large-Sized Autologous Breast Reconstruction using a Fleur-de-lys Profunda Femoris Artery Perforator Flap Design: A Report Comparing Results with the Horizontal Profunda Femoris Artery Perforator Flap

Cited by 28 publications

References 26 publications

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction

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

Alternative donor sites in autologous breast reconstruction: a clinical practice review of the PAP flap

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