Use of the Profunda Femoris Artery Perforator Flap for Reconstruction after Sarcoma Resection

Abstract

Background: Soft tissue sarcomas are rare neoplasms that can occur on any part of the body. The operative position for the resection is determined depending on the site of the soft tissue sarcomas; intraoperative repositioning may be needed for reconstruction. We present the profunda femoris artery perforator (PAP) flap harvest technique (wherein the flap can be used in any position), and suggest that the PAP flap transfer can eliminate the need for intraoperative repositioning. Methods: From December 2018 to January 2020, 7 patients with an average age of 68 years underwent reconstructions using a PAP flap after wide resection of STS. The mean defect size was 11.3 × 16.5 cm (range, 5.5–25 × 11–26 cm). The location of the defects was the medial thigh in 2 patients, the posterior thigh in 1, the popliteal fossa in 1, the groin in 1, and the buttock in 2. The PAP flap was elevated in the supine “frog-leg” position, the prone position, the jack-knife position, or the lateral “crisscross” position; the lateral decubitus position with the donor lower extremity on the bottom. Results: Of the 7 cases, the operations were performed in the supine “frog-leg” position in 3 cases, the prone position in 2 cases, the jack-knife position in 1 case, and the lateral “crisscross” position in 1 case. There were no intraoperative position changes in all cases. The mean size of the PAP flap was 8.7 × 19.9 cm (range, 6–11 × 17–24 cm). One patient had donor site dehiscence, which was treated conservatively. The PAP flaps survived completely in all cases. The mean follow-up period was 10.5 months (range, 6–17 months). Conclusion: Since the PAP flap elevation is feasible in every position, the PAP flap can be considered a versatile reconstruction option after sarcoma resection.

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

“…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.…”

“…When using perforator-to-perforator anastomosis, it is recommended to select a short-pedicled perforator flap (i.e., PAP, ALT, and SCIP flaps) to match the vessels caliber. 25 26…”

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).…”

Pedicled double‐paddle vertical posteromedial thigh flap for double‐layer closure and reconstruction of upper thigh defect after sarcoma resection: A case report

“…Similarly, the PAP flap, and its variation PMT flap, were mostly employed as a propeller flap. Their use is more commonly described for perineal defects (Kwon et al, 2021), although Karakawa, Karakawa et al, 2020 presented an interesting case series where the PAP flap was successfully used to cover soft tissue sarcoma defects throughout the thigh. The DIEP flap, instead, is not usually as a primary reconstructive option considered for this region.…”