Microvascular Reconstruction in the Upper Extremity with the Superthin Profunda Artery Perforator Flap: Clinical Outcomes
Chim Harvey, MD
Division of Plastic Surgery, University of Florida College of Medicine, Gainesville, FL
Introduction: For microvascular reconstruction in the hand and upper extremity, a thin flap with a concealed donor site is ideal. The profunda artery perforator (PAP) flap while having a concealed donor site on the posteromedial thigh, is thick when elevated in the traditional subfascial plane. Flap elevation in the superthin plane overcomes this issue, allowing a thin flap regardless of patient body mass index.
Materials and Methods: We describe our clinical experience with the superthin PAP flap for microvascular reconstruction in the hand and upper extremity in 11 consecutive patients. Preoperative perforator mapping was performed with computed tomography angiogram (CTA) and duplex ultrasound, allowing accurate localization of the dominant perforator for elevation of single perforator PAP flaps.
Results: Flap success rate was 100%. Indications for surgery included trauma (n=7), burn (n=3) and oncology (n=1). Mean patient age was 30 + 24 years. Mean patient BMI was 24.3 + 5.7 cm. Defects reconstructed were in the hand (n=5), wrist (n=2), forearm (n=2), elbow (n=1) and arm (n=1). Mean arterial diameter was 1.6 + 0.5 mm. All arterial anastomoses were end-to-side. Mean vein diameter was 2.1 + 0.3 mm. Mean pedicle length was 6.9 + 1.3 cm. Mean size of the defect covered was 157 + 61 cm2. Largest flap measured 23 x 10 cm. Mean flap thickness was 0.7 + 0.3 cm. Images show 6mm thick flap used for reconstruction of a dorsal hand defect.
Conclusions: The superthin PAP flap provides a new option with a concealed donor site in the posteromedial thigh for a “like for like” reconstruction of wounds in the hand and upper extremity.
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