The correlation of the perforators and the accessory saphenous vein in a profunda femoris artery perforator flap for additional venous anastomosis: A cadaveric study and clinical application

Karakawa, Ryo; Yoshimatsu, Hironobu; Fuse, Yuma; Hayashi, Akitatsu; Tanakura, Kenta; Heber, Ulrike; Weninger, Wolfgang J.; Tzou, Chieh‐Han John; Meng, Stefan; Yano, Tomoyuki

doi:10.1002/micr.30517

Cited by 9 publications

(10 citation statements)

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“…10 Satake et al and Karakawa et al also demonstrated similar results of the distance of the perforators from the groin crease and size of perforators. 9,17 Our findings demonstrate the mean dominant profunda perforator location is 7.04 cm distal to the IGF. With traditional tPAP flap design, this would result in an eccentrically located perforator since the inferior border of the tPAP flap is generally 6 to 8 cm inferior to the gluteal fold.…”

Section: Discussionmentioning

confidence: 62%

“…10 Satake et al and Karakawa et al also demonstrated similar results of the distance of the perforators from the groin crease and size of perforators. 9 17…”

Section: Discussionmentioning

confidence: 99%

“…The perforator anatomy of the PAP flap has been described in previous cadaveric and radiologic studies. 5 6 7 8 9 Haddock et al reported finding the perforators in relatively consistent locations medially in the vicinity of the adductor magnus and laterally in the vicinity of the biceps femoris and vastus lateralis. 6 Saad et al described the average distance of the target perforator for the transverse PAP (tPAP) pedicle as 3.5 cm inferior to the gluteal fold on dissection and 4.4 cm on computed tomography angiograms (CTA), 5 and the perforasome has been shown to extend beyond the previously accepted 7-cm width of the flap.…”

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confidence: 99%

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Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Artz

Atamian

Mulloy

et al. 2021

J Reconstr Microsurg

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Introduction While the originally described transverse profunda artery perforator (tPAP) flap is designed to capture the first profunda perforator, our group hypothesized the dominant perforator may not always be captured in this configuration. This study maps the location of dominant profunda perforators using imaging and cadaveric dissections to determine the probability of capturing dominant perforators with the transverse flap design versus the vertical PAP (vPAP) variant. Methods Fifty preoperative magnetic resonance angiogram or computed tomographic angiogram scans (100 total extremities) were examined from autologous breast reconstruction patients between 2015 and 2019. Profunda perforator characteristics that were examined included the distance from the pubic tubercle to the infragluteal fold (IGF), the distance of the perforators from the IGF, distance posterior to the gracilis, the diameter of the perforator at fascial exit, and total number of perforators present. Profunda perforator dissection was performed in 18 cadaveric extremities. Analysis included mean distance from pubic tubercle, distance posterior to the gracilis, diameter at fascial exit, and total number of perforators. Results In imaging analysis, the mean distance from the IGF to the fascial exit of all dominant perforators was 7.04 cm. The mean diameter of the dominant perforator at the fascial exit was 2.61 mm. Twenty-six thighs (26%) demonstrated dominant perforators that exited the fascia greater than 8 cm below the IGF. In cadaver dissections, the mean distance from the pubic tubercle to the fascial exit of all the dominant perforators was 10.17 cm. Nine cadaver specimens (50%) demonstrated perforators that exited the fascia greater than 8 cm below the estimated IGF. Conclusion The dominant perforator can often be missed in the traditional tPAP design. The vPAP incorporates multiple perforators with a long pedicle, excellent vessel diameter, and favorable donor-site.

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Section: Discussionmentioning

confidence: 62%

“…10 Satake et al and Karakawa et al also demonstrated similar results of the distance of the perforators from the groin crease and size of perforators. 9 17…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Artz

Atamian

Mulloy

et al. 2021

J Reconstr Microsurg

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“…One of the greatest advantages of the PAP flap is that a relatively large volume of flexible skin paddle and fat tissue with a long pedicle can be harvested from an inconspicuous donor site in every surgical position. [23][24][25] Therefore, PAP flap can be harvested from the thigh, which is slightly farther from the back, simultaneously with tumor resection. Especially in the prone position, PAP flap can be one of the optimal donor sites for reconstruction of the posterior trunk because of the limited number of flaps which can be elevated simultaneously.…”

Section: Discussionmentioning

confidence: 99%

An Anatomical Study of Posterior Trunk Recipient Vessels, and Comparisons of Outcome following Pedicled- and Free-Flap Transfers for Treatment of Sarcoma in the Posterior Trunk

Karakawa

Yoshimatsu

Kamiya

et al. 2022

J Reconstr Microsurg

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Background Reconstruction after wide resection of a large sarcoma arising in the posterior trunk may require free-flap transfer to reduce the postoperative complications. Here, we describe the recipient vessels on the whole posterior trunk. Moreover, to show the reliability of these vessels, we describe an institutional series of free-flap reconstruction. Methods In the cadaveric study, 20 posterior trunk regions from 10 fixed cadavers were dissected. The location and the diameter of the perforating artery and vein on the posterior were documented. In the clinical study, 54 patients undergoing immediate reconstruction surgery with only a pedicled flap (n = 45) and with a free flap (n = 9) after sarcoma resection on the posterior trunk between July 2005 and September 2021 were identified. One-to-one propensity score matching was performed to compare the postoperative complications. Results In the cadaveric study, a total of 178 perforators were identified. The average diameter of the superficial cervical artery (SCA) and vein, dorsal scapular artery (DSA) and vein, medial branch of dorsal intercostal artery perforator (m-DICAP) and vein, lateral branch of dorsal intercostal artery perforator (l-DICAP) and vein, and dorsolateral intercostal artery perforator (DLICAP) and vein were 1.03, 1.67, 1.38, 1.84, 1.28, 1.84, 1.01, 1.60, 1.11, and 1.70 mm. In the clinical study, the propensity score-matched analysis involving eight pairs showed a significantly higher occurrence of total complications in the pedicled-flap group than the free-flap group (62.5 vs. 0%, p = 0.03). Conclusion The cadaveric study showed that the perforators from the SCA, DSA, and posterior intercostal artery are constantly present. The clinical study demonstrated the feasibility and reliability of a free-flap transfer.

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“…Another limitation is the lack of description of the venous anatomy. However, the vascular anatomy of the gracilis muscle flap is well described in the literature (Azizzadeh & Pettijohn, 2020) and also, the accessory saphenous vein can be included in the PAP flap to decrease the chances of congestion of the skin island (Karakawa et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background The possibility of harvesting the profunda artery perforator (PAP) flap in a chimeric configuration together with the innervated gracilis muscle may be a good option for dynamic reconstruction following total glossectomies. In this paper, we present a retrospective radiological study, which evaluates the presence and characteristics of the anatomical variation of the chimeric PAP – gracilis flap. Methods The study sample comprised 66 patients (132 legs), 38 men, and 28 women with an average age of 56 ± 2 years old, who underwent head and neck reconstruction with a free flap. Preoperative computed tomographic angiography (CTA) was used for morphologic analysis. We present a case report of a patient with a total glossectomy reconstructed with this flap. Results A perforator in the PAP area joining with the main pedicle of the gracilis muscle was found in 38 legs (28.8%). Mean length of the pedicle from the profunda femoral artery to the point where the perforator in the PAP area and the pedicle of the gracilis joined was 3.0 ± 0.3 cm. Differences in the existence of this vascular configuration were not significant comparing groups by sex, BMI, height, side or source vessel. Motion of the new tongue was documented clinically and with electromyography. The patient achieved an intelligible speech and normal diet. Conclusions Preoperative evaluation is necessary to assess the existence of a perforator in the PAP area joining with the main pedicle of the gracilis muscle. This chimeric flap has been demonstrated useful for dynamic reconstruction of a patient with a total glossectomy.

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The correlation of the perforators and the accessory saphenous vein in a profunda femoris artery perforator flap for additional venous anastomosis: A cadaveric study and clinical application

Cited by 9 publications

References 20 publications

Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

An Anatomical Study of Posterior Trunk Recipient Vessels, and Comparisons of Outcome following Pedicled- and Free-Flap Transfers for Treatment of Sarcoma in the Posterior Trunk

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

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