The profunda artery perforator free flap for lower extremity reconstruction

Abstract

Background: The profunda artery perforator (PAP) flap has been reported in several types of reconstructions. This report aims to evaluate the usefulness and the clinical outcome of patients who underwent the PAP free flap for lower limb reconstruction.Methods: Between February 2018 and February 2020, nine patients with injury at lower third of the leg, foot dorsum or foot plant (eight acute injuries and one chronic ulcer) were selected. Mean wound size was 12.5 × 6.3 cm (9 × 5-14.5 × 6.5). Inclusion criteria consisted in patient's request to hide the donor site scar and the absence of previous traumas or surgery in the donor site. Patients considered unable to bear prolonged surgery were excluded. Patients underwent preoperative CT angiography and peri-operative Doopler, for perforator selection. All flaps were designed with pinch test, in elliptical shape. Microvascular anastomosis was performed to the tibialis anterior/posterior or medial plantar vessels. Outcomes were evaluated in terms of wound coverage success and patient's quality of life through Lower Extremity Functional Scale (LEFS) questionnaire. Results:The mean size of the harvested skin paddle was 13.5 × 7.4 cm (9 × 6-15 × 8) and mean pedicle length was 8.5 cm. Mean flap harvest time was 43.5 min . Flap survival rate was 100%, with one re-exploration with minimal partial flap loss. Mean follow-up was 13.5 months . Reconstructive results were successful in wound coverage and function. All patients reported satisfaction with their result by LEFS questionnaire (score:64.7). Conclusion:With proper patient selection, there was 100% flap survival rate with no major complication. According to our data, the PAP free flap could be a valuable option for lower extremity reconstruction. | INTRODUCTIONInjury to the lower limb poses a challenge to reconstructive surgeons because they require early intervention often involving a multidisciplinary approach. Initial management of the affected extremity will be determined by the cause of injury, as it is necessary to stabilize the patient and determine suitable reconstructive options. These injuries include trauma (crushing, car accidents, high altitude falls) and high voltage burns among others (Patterson et al., 2019). Every patient should receive individualized treatment tailored to the injury and it will

The profunda artery perforator flap for upper limb reconstruction: A case report and literature review on the flap applications in reconstruction

“…Recently, the PAP flap has been described as an option for lower limb reconstruction both as a pedicled flap by Karakawa, Yoshimatsu, Maeda, et al (2020) and as a free transfer by Ciudad et al (2022).…”

“…According to recent publications (Atzeni et al, 2021 ), the rate of donor site complications in PAP flap reconstruction is low and these include seroma (2.6%), wound dehiscence (2.6%), and infection (0%). Recently, the PAP flap has been described as an option for lower limb reconstruction both as a pedicled flap by Karakawa, Yoshimatsu, Maeda, et al ( 2020 ) and as a free transfer by Ciudad et al ( 2022 ). Another application is perineal reconstruction as described by Chang et al ( 2016 ) and Huang et al ( 2015 ) who report their experience in vulvar reconstruction with pedicled PAP flap.…”

“…The profunda femoris artery perforator (PAP) flap has been recently popularized as an alternative option for microsurgical reconstruction Filippo Boriani and Paolo Sassu equally contributed to the idea, the development and the editing of the study. (Atzeni et al, 2021;Cho et al, 2021;Ciudad et al, 2022;Heredero et al, 2021;Jo et al, 2022;Karakawa, Yoshimatsu, Fuse, et al, 2020;Kehrer et al, 2018;Martinez et al, 2021;Murphy et al, 2021). Historically, based on proximal musculocutaneous perforators from the adductor magnus (AM) muscle, it was initially referred as "adductor flap" by Angrigiani et al (2001).…”

Combined lymph node transfer and suction‐assisted lipectomy in lymphedema treatment: A prospective study

“…The flaps were then inset at two different levels for each extremity. In particular, in the lower extremity, one flap was anastomosed to the medial plantar vessels at the ankle level and the second one to the medial sural artery and venae comitantes in the popliteal fossa (Figure 1) (Bulla et al, 2019; Ciudad, Kaciulyte, et al, 2021). In the upper limb, one flap was anastomosed to the anterior ulnar recurrent artery and basilic vein at the level of the cubital and the second flap was anastomosed to a branch of the radial artery and a comitant vein at the volar aspect of the wrist.…”

Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis

“…After Mardini et al (2003) introduced the concept of free‐style flaps into perforator flaps, they were widely used in reconstructive surgery. Perforator flaps have many advantages, including providing extensive soft tissue, at least one reliable perforator, a long vascular pedicle, no need to ensure obvious muscle and less donor site weakness and morbidity (Ciudad et al, 2021; Kamali et al, 2017; Lee et al, 2019; Tang et al, 2013; Wang et al, 2019). Commonly, used perforator flaps include the anterolateral thigh perforator flap (ALTPF), deep inferior epigastric artery flap (DIEPF), profunda artery perforator flap (PAPF), medial sural artery perforator flap (MSAP), thoracodorsal artery perforator flap (TAPF), and lower medial thigh perforator flap (LMTPF).…”