gms | German Medical Science

Background: The widespread use of perforator flaps has allowed the transfer of large amounts of soft tissue for the purpose of reconstruction or defect coverage with reduced donor site morbidity. We present an option, which uses available tissue from either the medial or the posterior thigh based on profunda femoris perforators. We illustrate the versatile use of various posterior thigh flap designs including breast, head and neck, and extremity reconstructions.

Overview of the Anatomy: The anatomy of the profunda femoris artery and its perforators is very reliable and does not require routine preoperative imaging. Several perforators are routinely encountered which can be detected with a hand held doppler device making it possible to perform chimeric flaps that are suitable for three dimensional reconstructions. Because of these features, this flap can be raised with relative speed, making it ideal for raising double flaps for bilateral breast reconstruction or large defect coverage. An elliptical skin paddle design measuring up to 28 x 9cm is possible when designed vertically in the medial thigh and up to 27 x 7cm with horizontal design 1cm inferior to the gluteal crease. The flap has good pedicle length and is approximately 7 to 13cm long.

Results: 13 flaps were performed in total. The reliable vascular anatomy, size of perforators and pedicle length allowed the reconstruction of various types of defects. All flaps performed were successful. Donor sites were all closed primarily and were well tolerated.

Conclusions: The PAP-Flap is an excellent choice for reconstructive purposes, either primarily or when other routine options are not available.