Neurotized Diagonal Profunda Artery Perforator Flaps for Breast Reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Deep inferior epigastric artery perforator flaps are standard for breast reconstruction but unsuitable for all patients.
• Thigh-based flaps like DUG and PAP have distinct advantages and disadvantages.
• Patient selection is crucial for optimizing outcomes in autologous breast reconstruction.

Purpose of the Study:

• To report the first sensate diagonal profunda artery perforator (PAP) flap for breast reconstruction.
• To combine the benefits of the diagonal upper gracilis (DUG) and PAP flaps.
• To evaluate the safety and reliability of this novel flap in a patient with paraplegia and leg swelling.

Main Methods:

• Description of a novel sensate diagonal PAP flap technique.
• Utilizing preoperative imaging and specific markings for flap design.
• Detailed presentation of surgical technique and postoperative results in a sentinel case.

Main Results:

• The diagonal PAP flap provided ample tissue for breast reconstruction with a 2-team approach.
• Potential for neurotization achieved breast sensibility.
• Wound closure aligned with resting skin tension lines, avoiding lower extremity lymphatic drainage.

Conclusions:

• The diagonal PAP flap is a safe and reliable muscle-sparing alternative for breast reconstruction.
• This technique minimizes lymphedema risk compared to other thigh flaps.
• Further studies are needed to assess donor site morbidity.