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The Vertical Profunda Artery Perforator Flap for Perineal Reconstruction
Jennifer L Lavie1, Richard F Guidry1, Patrick A Palines1
1From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Annals of Plastic Surgery
|July 18, 2024
Summary
Vertical profunda artery perforator (vPAP) flaps offer a reliable solution for reconstructing complex perineal defects after abdominoperineal resection (APR). This flap technique demonstrates low donor-site morbidity and successful defect obliteration in various patient cases.
Area of Science:
- Surgical Reconstruction
- Oncology
- Plastic Surgery
Background:
- Colorectal cancer significantly contributes to cancer-related mortality in the US.
- Abdominoperineal resection (APR) is a critical procedure for many patients, often resulting in complex tissue voids.
- Pedicled vertical profunda artery perforator (vPAP) flaps are an option for defect obliteration, especially in minimally invasive APR or when abdominal donor sites are unavailable.
Purpose of the Study:
- To evaluate the efficacy and outcomes of pedicled vPAP flap reconstruction for defects following abdominoperineal resection (APR).
- To assess complications and success rates of vPAP flap reconstruction in a single-center retrospective cohort.
Main Methods:
- A retrospective cohort study was conducted from January 2020 to December 2021.
- Pedicled vPAP flap reconstruction for APR defects was assessed.
- Patient demographics, diagnoses, comorbidities, radiation history, timing of reconstruction, and complications were analyzed.
Main Results:
- Ten patients (70% male, average age 56.2 years) underwent vPAP flap reconstruction.
- Rectal adenocarcinoma was the most common indication (50%).
- Major complications included venous congestion and partial flap failure (20% each); minor complications involved perineal dehiscence (50%) and abscesses (30%). No complete flap loss occurred.
Conclusions:
- Pedicled vPAP flaps are a reliable method for reconstructing perineal defects.
- This technique offers reduced donor-site morbidity compared to alternative reconstructive options.
- vPAP flaps are recommended for delayed reconstruction, minimally invasive APRs, and abdominal donor site unavailability.
