Evolution, Anatomy, Advantages and Disadvantages, and Harvest Techniques of Profunda Artery Perforator Flap

  • Chapter
  • First Online:
Oncoplastic Flap Surgery

Abstract

In 1987, Taylor and Palmer introduced the concept of vascular territories (angiosomes) [1], and then koshima and SOEDA reported the perforator flap technology [2]. Various forms of free flaps have been applied to many parts of the human body and different fields of surgery and have become important technical means in plastic reconstruction surgery [3].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (France)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 160.49
Price includes VAT (France)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
EUR 147.69
Price includes VAT (France)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
EUR 210.99
Price includes VAT (France)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(2):113–41.

    Article  CAS  PubMed  Google Scholar 

  2. Koshima I, Soeda S. Deep inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42(6):645–8.

    Article  CAS  PubMed  Google Scholar 

  3. Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg. 2009;123(4):132e–45e.

    Article  CAS  PubMed  Google Scholar 

  4. Patel NG, Ramakrishnan V. Microsurgical tissue transfer in breast reconstruction. Clin Plast Surg. 2017;44(2):345–59.

    Article  PubMed  Google Scholar 

  5. Healy C, Allen RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg. 2014;30(2):121–5.

    PubMed  Google Scholar 

  6. Zhang S, Song D. The discovery, development history and clinical implications of perforator flaps. Chin J Reparat Reconstr Surg. 2017;07:769–72.

    Google Scholar 

  7. Ahmadzadeh R, Bergeron L, Tang M, Geddes CR, Morris SF. The posterior thigh perforator flap or profunda femoris artery perforator flap. Plast Reconstr Surg. 2007;119(1):194–200; discussion 201–2.

    Article  CAS  PubMed  Google Scholar 

  8. Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap: a new option for autologous breast reconstruction—a cadaveric and computer tomography angiogram study. J Reconstr Microsurg. 2012;28(6):381–6.

    PubMed  Google Scholar 

  9. Dajiang Song, Zan Li, **ao Zhou. Application of profunda femoral artery perforator flap in breast reconstruction. Chin J Plast Surg2017. (6): 412–416.

    Google Scholar 

  10. Fosseprez P, Gerdom A, Servaes M, Deconinck C, Pirson G, Berners A. [Profunda artery perforator flap: reliable secondary option for breast reconstruction?]. Ann Chir Plast Esthet. 2017;62(6):637–45.

    Google Scholar 

  11. Angrigiani C, Grilli D, Thorne CH. The adductor flap: a new method for transferring posterior and medial thigh skin. Plast Reconstr Surg. 2001;107(7):1725–31.

    Article  CAS  PubMed  Google Scholar 

  12. Fujii M, Terashi H, Hashikawa K, Tahara S. Functional reconstruction of large anogenital defects with bilateral V-Y advancement posterior thigh fasciocutaneous flaps. J Plast Reconstr Aesthet Surg. 2007;60(11):1208–13.

    Article  PubMed  Google Scholar 

  13. Unal C, Ozdemir J, Yirmibesoglu O, Yucel E, Agir H. Use of inferior gluteal artery and posterior thigh perforators in management of ischial pressure sores with limited donor sites for flap coverage. Ann Plast Surg. 2012;69(1):67–72.

    Article  CAS  PubMed  Google Scholar 

  14. Dajiang Song, Zan Li, **ao Zhou. Free profunda femoral artery pedicled gracilis chimeric musculocutaneous perforator flap for repair of defects after oral and buccal cancer surgery Chin J Plast Surg2017. 33(4): 242–247.

    Google Scholar 

  15. Dajiang Song, Zan Li, **ao Zhou. Clinical application of free medial femoral chimeric perforator myocutaneous flap in the repair of defects after tongue cancer surgery. Chin J Otorhinolaryngol Head Neck Surg2017. 52(4): 278–282.

    CAS  Google Scholar 

  16. Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg. 2012;129(1):16e–23e.

    Article  PubMed  Google Scholar 

  17. Allen RJ, Lee ZH, Mayo JL, Levine J, Ahn C, Allen RJ. The profunda artery perforator flap experience for breast reconstruction. Plast Reconstr Surg. 2016;138(5):968–75.

    Article  CAS  PubMed  Google Scholar 

  18. Satake T, Muto M, Ko S, Yasumura K, Ishikawa T, Maegawa J. Breast reconstruction using free posterior medial thigh perforator flaps: intraoperative anatomical study and clinical results. Plast Reconstr Surg. 2014;134(5):880–91.

    Article  CAS  PubMed  Google Scholar 

  19. Haddock NT, Gassman A, Cho MJ, Teotia SS. 101 consecutive profunda artery perforator flaps in breast reconstruction: lessons learned with our early experience. Plast Reconstr Surg. 2017;140(2):229–39.

    Article  CAS  PubMed  Google Scholar 

  20. Blechman KM, Broer PN, Tanna N, Ireton JE, Ahn CY, Allen RJ. Stacked profunda artery perforator flaps for unilateral breast reconstruction: a case report. J Reconstr Microsurg. 2013;29(9):631–4.

    Article  PubMed  Google Scholar 

  21. Zhou X, Song D, Li Z. The development of perforator flap and its application in oncoplastic surgery. Chin J Aesthet Plast Surg. 2017;28(2):69–72.

    Google Scholar 

  22. Dajiang Song, Zan Li, **ao Zhou. Observation of curative effect of different forms of free profunda femoral artery pedicle chimeric perforator myocutaneous flap in the repair of defects after tongue cancer surgery. Chin J Reparat Reconstr Surg2017. 31(06): 696–701.

    Google Scholar 

  23. Hupkens P, Ozturk E, Wittens S, Hoevenaren IA, Kooloos JG, Ulrich DJ. Posterior thigh perforator flaps: an anatomical study to localize and classify posterior thigh perforators. Microsurgery. 2013;33(5):376–82.

    Article  PubMed  Google Scholar 

  24. Haddock NT, Greaney P, Otterburn D, Levine S, Allen RJ. Predicting perforator location on preoperative imaging for the profunda artery perforator flap. Microsurgery. 2012;32(7):507–11.

    Article  PubMed  Google Scholar 

  25. DeLong MR, Hughes DB, Bond JE, Thomas SM, Boll DT, Zenn MR. A detailed evaluation of the anatomical variations of the profunda artery perforator flap using computed tomographic angiograms. Plast Reconstr Surg. 2014;134(2):186e–92e.

    Article  CAS  PubMed  Google Scholar 

  26. Scaglioni MF, Kuo YR, Yang JC, Chen YC. The posteromedial thigh flap for head and neck reconstruction: anatomical basis, surgical technique, and clinical applications. Plast Reconstr Surg. 2015;136(2):363–75.

    Article  CAS  PubMed  Google Scholar 

  27. Haddock N, Nagarkar P, Teotia SS. Versatility of the profunda artery perforator flap: creative uses in breast reconstruction. Plast Reconstr Surg. 2017;139(3):606e–12e.

    Article  CAS  PubMed  Google Scholar 

  28. Ratanshi I, McInnes CW, Islur A. The proximal superficial femoral artery perforator flap: anatomic study and clinical cases. Microsurgery. 2017;37(6):581–8.

    Article  PubMed  Google Scholar 

  29. Blondeel PN, Van Landuyt KH, Monstrey SJ, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003;112(5):1378–83; quiz 1383, 1516; discussion 1384–7.

    Article  PubMed  Google Scholar 

  30. Sinna R, Boloorchi A, Mahajan AL, Qassemyar Q, Robbe M. What should define a “perforator flap”. Plast Reconstr Surg. 2010;126(6):2258–63.

    Article  CAS  PubMed  Google Scholar 

  31. Shieh SJ, Chiu HY, Yu JC, Pan SC, Tsai ST, Shen CL. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg. 2000;105(7):2349–57; discussion 2358–60.

    Article  CAS  PubMed  Google Scholar 

  32. Hurwitz ZM, Montilla R, Dunn RM, Patel NV, Akyurek M. Adductor magnus perforator flap revisited: an anatomical review and clinical applications. Ann Plast Surg. 2011;66(5):438–43.

    Article  CAS  PubMed  Google Scholar 

  33. Agrawal MD, Thimmappa ND, Vasile JV, et al. Autologous breast reconstruction: preoperative magnetic resonance angiography for perforator flap vessel map**. J Reconstr Microsurg. 2015;31(1):1–11.

    PubMed  Google Scholar 

  34. Buescher TM, Andry D, Brown T, Vargo J, Nazir N, Andrews BT. Inset of unilateral dual microvascular breast reconstruction using nonabdominal free tissue transfer. Plast Reconstr Surg. 2016;138(1):42–8.

    Article  CAS  PubMed  Google Scholar 

  35. Ito R, Huang JJ, Wu JC, Lin MC, Cheng MH. The versatility of profunda femoral artery perforator flap for oncological reconstruction after cancer resection—clinical cases and review of literature. J Surg Oncol. 2016;114(2):193–201.

    Article  PubMed  Google Scholar 

  36. Scaglioni MF, Chen YC, Lindenblatt N, Giovanoli P. The vertical posteromedial thigh (vPMT) flap for autologous breast reconstruction: a novel flap design. Microsurgery. 2017;37(5):371–6.

    Article  PubMed  Google Scholar 

  37. Stalder MW, Lam J, Allen RJ, Sadeghi A. Using the retrograde internal mammary system for stacked perforator flap breast reconstruction: 71 breast reconstructions in 53 consecutive patients. Plast Reconstr Surg. 2016;137(2):265e–77e.

    Article  CAS  PubMed  Google Scholar 

  38. Buescher T, Przylecki WH, Holding J, et al. Evaluation of complications associated with flap/pedicle inset techniques for unilateral breast reconstruction utilizing dual transverse upper gracilis (TUG) or profunda artery perforator (PAP) flaps. Plast Reconstr Surg. 2015;136(4 Suppl):90–1.

    Article  Google Scholar 

  39. Hupkens P, Hameeteman M, Westland PB, Slater NJ, Vasilic D, Ulrich DJ. Breast reconstruction using the geometrically modified profunda artery perforator flap from the posteromedial thigh region: combining the benefits of its predecessors. Ann Plast Surg. 2016;77(4):438–44.

    Article  CAS  PubMed  Google Scholar 

  40. Song D, Li Z, Zhou X. Observation of curative effect of free sensory ultra-thin anterolateral thigh perforator flap in repairing wounds at donor site. Chin J Reparat Reconstr Surg. 2017;31(08):987–91.

    Google Scholar 

  41. **e S, Deng X, Chen Y, et al. Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap. J Plast Surg Hand Surg. 2016;50:1–8.

    Article  Google Scholar 

  42. Kimura N. A microdissected thin tensor fasciae latae perforator flap. Plast Reconstr Surg. 2002;109(1):69–77; discussion 78–80.

    Article  PubMed  Google Scholar 

  43. Koshima I, Fukuda H, Yamamoto H, Moriguchi T, Soeda S, Ohta S. Free anterolateral thigh flaps for reconstruction of head and neck defects. Plast Reconstr Surg. 1993;92(3):421–8; discussion 429–30.

    Article  CAS  PubMed  Google Scholar 

  44. Scaglioni MF, Eder M, Giovanoli P. The use of inverted-L posteromedial thigh (L-PMT) flap for autologous breast reconstruction: a case report. Microsurgery. 2018;38(5):558–62.

    Article  PubMed  Google Scholar 

  45. Date S, Ciudad P, Maruccia M, Chen HC. Breast reconstruction using the geometrically modified profunda artery perforator flap from the posteromedial thigh region: combining the benefits of its predecessors. Ann Plast Surg. 2017;79(1):124.

    Article  CAS  PubMed  Google Scholar 

  46. Wong C, Nagarkar P, Teotia S, Haddock NT. The profunda artery perforator flap: investigating the perforasome using three-dimensional computed tomographic angiography. Plast Reconstr Surg. 2015;136(5):915–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Shanghai Scientific and Technical Publishers

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Song, D., Mitsunaga, N. (2023). Evolution, Anatomy, Advantages and Disadvantages, and Harvest Techniques of Profunda Artery Perforator Flap. In: Li, Z., Song, D. (eds) Oncoplastic Flap Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-19-8926-1_19

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-8926-1_19

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-8925-4

  • Online ISBN: 978-981-19-8926-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Navigation