Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Profunda Artery Perforator Flap Perforasome Territories: Implications of Vascular Anatomy for Optimal Flap Design in Reconstructive Microsurgery
Anita T. Mohan, MRCS MBBS BSc1, L Zhu, MD2, C Rammos, MD2, G Michalak, PhD2, N Lachman, PhD2, Steve Moran, MD2, Michel Saint-Cyr, MD2.
1Mayo Clinic, ROchester, MN, USA, 2Mayo Clinic, Rochester, MN, USA.

PURPOSE:Recently the profunda artery perforator (PAP) flap has been incorporated into the armamentarium for autologous breast reconstruction. Anatomical dissections have identified consistent musculocutaneous perforators originating from the adductor magnus. The donor site has a low associated morbidity and can be concealed within the gluteal fold. This study aims to delineate the perforasome of the PAP flap and correlate the vascular territories with the anatomical location of fasciocutaneous perforators. Implications for both regional and free flap reconstruction and flap designs will be discussed.

METHODS:This study involved 18 flaps raised using fresh cadaveric specimens incorporating the entire posterior thigh skin. The perforators supply the PAP flap were identified and documented for size, branching patterns, course and location. Individual perforators were injected with an iodinated contrast medium to assess filling patterns and vascular territories of individual PAP flap perforasomes with ultrahigh resolution Computed Tomography (CT). Data analysis was performed with 3D volume rendering and regions of interest measurements within the skin integument. Inter-perforator flow was assessed in the posterior thigh: a comparison of medial and posterior midline perforators, and the relationship to the vascular territory of the distal PAP perforasome.

RESULTS:Preliminary data identified a mean perfusion area of 260.8.cm2 (SD=52). Mean perforator distance from the inferior gluteal crease 10.2cm (SD=5.2), and within 2cm of the posterior midline of the thigh. The average pedicle length was 11.3cm, with a diameter the origin of 3.4mm and 1.8mm at the fascial level. Posterior midline perforators demonstrated transverse direct and indirect linking vessels with bidirectional flow in the horizontal orientation and extension of the perforasome to the lateral midline of the thigh. Interperforator examination of the distal perforator, which lies 5-8cm from the popliteal crease in the posterior midline of the thigh, shared a similar vascular perforasome territory to a posterior midline proximal perforator. There was a longitudinal direct linking vessel between the distal and proximal perforators.

CONCLUSION: This study provides further information to the potential limits of flap perfusion and the presence of dominant linking vessels between perforators provides further knowledge on density of dominant perforators and a perfusion roadmap of the posterior thigh. This can be translated to modifications of flap design to incorporate more autologous tissue and new skin paddle designs or both regional and free flap reconstruction.

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