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Updated: Aug 6, 2026
An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Determining the best recipient vessel site for autologous microsurgical breast reconstruction using PAP flaps: An
Martin Lhuaire1, Theo Sedbon2, David Biau3
1Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France; In vivo Imaging Research team, PARCC - Inserm UMR_S 970, Hôpital Européen Georges Pompidou, Université Paris Cité, Paris, France; Department of Anatomy and Organogenesis, Faculté de Médecine, Université Paris Cité, Paris, France; Divison of Anatomy, Department of Surgery, School of Medicine, University of California San Diego Health, La Jolla, CA, United States; Anatomy Laboratory, School of Surgery, Assistance Publique - Hôpitaux de Paris, Paris, France.
Introduction:
Since its first description in 2012, the profunda femoris artery perforator (PAP) flap has gained increasing popularity and has progressively become the second-line option for autologous breast reconstruction. As with the deep inferior epigastric artery perforator (DIEP) flap, several recipient vascular pedicles, including the internal thoracic, thoracodorsal, and circumflex scapular pedicles, have been described for microvascular anastomoses. The aim of this anatomical observational study was to identify the optimal recipient site for PAP flap by determining the best donor-recipient vessel diameter match among these three potential pedicles.
Methods:
This study was based on 100 dissections of the three anatomical regions of interest, performed bilaterally in 50 fresh female cadavers. The internal vessel diameters were measured using a vascular gauge ranging from 1.0 to 5.0 mm, with successive 0.5-mm graduations.
Results:
The median diameter of the PAP, internal thoracic (ITA), circumflex scapular (CSA) and thoracodorsal (TDA) arteries were: 2.0, 2.5, 2.5, and 2.0 mm, respectively. The median diameter of profunda femoris pedicle perforator (PVP), internal thoracic (ITV), circumflex scapular (CSV), and thoracodorsal (TDV) veins were: 3.0, 2.5, 3.0, and 2.5 mm, respectively. At the individual level, a perfect match between PAP and TDA was significantly more frequent than between PAP and CSA (p = 0.037), whereas no significant difference was observed between PAP and ITA compared with either PAP and TDA or PAP and CSA. For the venous system, a perfect match between PVP and CSV was significantly more frequent than that between PVP and ITV (p= 0.0088); however, no significant differences were found between PVP and ITV compared with PVP and TDV or between PVP and CSV compared with PVP and TDV.
Conclusions:
This study supports the thoracodorsal artery and circumflex scapular veins as the preferred recipient vessels, which, from an anatomical standpoint, provide the closest diameter match with the donor pedicles.
