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The Profunda Artery Perforator Flap(PAP): A New Flap for Breast Reconstruction
Maria M. LoTempio, MD1; Nicholas Haddock, MD2; Alireza Sadeghi, MD3, Christina Ahn, MD2; Robert J. Allen, MD4
1Plastic Surgery, Medical University of South Carolina, Charleston, SC, 2NYU, New York, NY, 3LSU, New Orleans, LA, 4Plastic Surgery, Louisiana State University Health Science Center, New Orleans, LA
Introduction: There are several perforator autolgous tissue options for breast reconstruction. The deep inferior epigastric perforator flap remains the most common in the armentarium for perforator flaps. However, more women today have undergone abdominoplasty and/or liposuction, which render the abdominal tissue unusable. Additional donor sites are sought after. The buttock and thigh becomes the most likely source of additional tissue. We present a new flap for breast reconstruction the PAP flap, which allows the tissue in the posterior thigh to be used with minimal donor site morbidity and an extremely favorable cosmetic result.
Methods: A retrospective review from October 2010 to the present, we present 36 cases of the PAP flap. All patients were operated in a hospital setting and had a typical perforator course postoperatively. A skin paddle measuring 7 X 22 cm was drawn inferior to the gluteal crease. The dissections was full thickness identifying the second profunda perforator. This is followed until the take off of the femoral artery. Once the vessels are ligated, the tissues is brought up to the chest and anastomose to the internal mammary artery and vein.
Results: All patients received a favorable cosmetic result. There hospital stay averaged three days and the operative time ranged from 3-5 hours depending on unilateral versus bilateral reconstruction. One patient developed a donor site hematoma resulting in a wound dehiscence, but healed favorably without need for additional surgery. Compared to the transverse upper gracilis flap (TUG) the scar is hidden in the crease of the buttock fold versus the anterior thigh. There has been no incidence of lymphedema reported with the PAP compared to the TUG, which can have a 10% chance of lymphedema.
Conclusion: We present a new technique of 36 PAP flaps for breast reconstruction. This is a favorable option for breast reconstruction for women who do not have abdominal tissue available. The technique has minimal donor site morbidity and an excellent cosmetic outcome.
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