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Sonda R, Atzeni M, Martini F, Kohlschëen E, Monticelli A, Baruffaldi-Preis FW, Saba L, Bassetto F, Tiengo C, Figus A. The profunda artery perforators: Anatomical study and radiological findings using computed tomography angiography in patients undergoing PAP flap breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 89:164-173. [PMID: 38199218 DOI: 10.1016/j.bjps.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/16/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The popularity of the profunda femoris artery perforator (PAP) flap is increasing; however, knowledge concerning the standardization of radiological findings and their clinical implications is limited. We evaluated the radiological architecture of posterior thigh perforators using Computed Tomography Angiography (CTA) to identify landmarks to facilitate flap dissection. METHODS A retrospective study was conducted on 35 patients who underwent unilateral breast reconstruction with a PAP flap. The preoperative CTA scans were analyzed, and the perforator characteristics were evaluated. The perforators were mapped using a Cartesian coordinate system. Data were normalized by anatomical landmarks and overlapped. Perioperative and postoperative results were analyzed. Radiological and intraoperative were compared. RESULTS Two CTA scans were excluded; 66 thighs were examined. The mean perforator number was 3.2. The mean diameter of chosen perforators was 2.7 mm (DS ± 0.6 mm) at the origin, 2.2 mm (DS ± 0.4 mm) at the adductor space midpoint, and 1.7 mm (DS ± 0.3 mm) at the deep fascia. The mean adipose tissue thickness was 3.35 cm (DS ± 0.94) at the deep fascia and 3.59 cm (DS ± 1.19) at the adductor space midpoint. Intraoperatively, the perforator was located 3.22 cm (DS ± 0.87) from the posterior border of the gracilis muscle and 8.98 cm (DS ± 1.44) from the inferior gluteal crease. A radiological area located 9.33 cm (DS ± 4.81) from the y-axis and 7.48 cm (DS ± 1.88) from the x-axis was identified. CONCLUSIONS CTA using the volume-rendering technique is a valuable method to study in vivo the radiological anatomy of the posterior thigh perforators.
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Affiliation(s)
- Regina Sonda
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, Neuroscience Department, Padua University Hospital, Padua, Italy; Department of Surgical Sciences, Faculty of Medicine and Surgery, Plastic Surgery and Microsurgery Unit, University Hospital "Duilio Casula," University of Cagliari, Cagliari, Italy
| | - Matteo Atzeni
- Department of Surgical Sciences, Faculty of Medicine and Surgery, Plastic Surgery and Microsurgery Unit, University Hospital "Duilio Casula," University of Cagliari, Cagliari, Italy
| | - Federica Martini
- Department of Plastic Surgery and Burn Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Eva Kohlschëen
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, Neuroscience Department, Padua University Hospital, Padua, Italy
| | - Andrea Monticelli
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, Neuroscience Department, Padua University Hospital, Padua, Italy
| | | | - Luca Saba
- Clinic of Radiodiagnostic, Department of Radiology, University Hospital "Duilio Casula," University of Cagliari, Cagliari, Italy
| | - Franco Bassetto
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, Neuroscience Department, Padua University Hospital, Padua, Italy
| | - Cesare Tiengo
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, Neuroscience Department, Padua University Hospital, Padua, Italy
| | - Andrea Figus
- Department of Surgical Sciences, Faculty of Medicine and Surgery, Plastic Surgery and Microsurgery Unit, University Hospital "Duilio Casula," University of Cagliari, Cagliari, Italy.
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