The Superthin Profunda Artery Perforator Flap for Extremity Reconstruction: Clinical Implications

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Traditional subfascial harvest of profunda artery perforator flaps often yields thick flaps requiring secondary thinning for extremity wound coverage.
• Thin and superthin flaps offer potential advantages in reducing bulk and improving aesthetic and functional outcomes.

Purpose of the Study:

• To describe the author's technique and experience using thin and superthin profunda artery perforator flaps for extremity reconstruction.
• To evaluate the efficacy and accuracy of preoperative imaging in guiding flap harvest.

Main Methods:

• Ten consecutive patients underwent extremity reconstruction using thin or superthin profunda artery perforator flaps.
• Preoperative perforator localization was performed using computed tomography angiogram, color Doppler, and handheld Doppler.
• A single dominant perforator was used for each flap harvest.

Main Results:

• Mean flap thickness was 0.7 ± 0.2 cm, with favorable flap artery (16 ± 3 mm) and vein (21 ± 6 mm) diameters and a mean pedicle length of 6.8 ± 1.2 cm.
• Preoperative computed tomography angiogram measurements for proximal-distal distance were accurate, with a mean intraoperative difference of 1.2 ± 0.6 cm in all cases.
• Flaps successfully covered upper (n=3) and lower (n=7) extremity wounds.

Conclusions:

• Thin and superthin profunda artery perforator flaps are viable and advantageous options for extremity reconstruction.
• Preoperative imaging facilitates accurate perforator identification and dissection, ensuring reliable flap harvest.
• These flaps provide a valuable reconstructive tool with benefits including a concealed donor site and straightforward dissection.