Introduction of the L-PAP Flap: Bipedicled, Conjoined, and Stacked Thigh-Based Flaps for Autologous Breast Reconstruction.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
medline:
30
11
2023
pubmed:
4
4
2023
entrez:
3
4
2023
Statut:
ppublish
Résumé
Thigh-based flaps are increasingly popular options for autologous breast reconstruction in the setting of abdominal donor-site inadequacy, previous surgery, or patient preference, but the volume and skin associated with these flaps are often lacking relative to the abdomen. An individualized, shared decision-making approach to donor-site selection was adopted based on body shape, surgical history, lifestyle, reconstructive needs, and patient expectations. Different thigh-based flaps combined in stacked, bipedicled, or conjoined configurations were selected to maximize efficient use of available soft-tissue skin and volume while optimizing donor-site aesthetics. A total of 23 thigh-based stacked, bipedicled, or conjoined profunda artery perforator (PAP), lateral thigh perforator (LTP), or gracilis musculocutaneous flap components were used in six patients. Configurations included bilateral stacked PAP and LTP flaps, bipedicled posterolateral thigh flaps based on the LTP and PAP (L-PAP), and bipedicled thigh flaps based on the gracilis and PAP pedicles. Most anastomoses were performed to the antegrade and retrograde internal mammary vessels; intraflap anastomoses were performed in one case. There were no partial or total flap losses. There was one donor-site seroma. Design of stacked, bipedicled, and conjoined thigh-based flaps using multiple conventional flap components allows for tailored approaches to donor-site utilization based on individual body shape in selected patients. Bipedicled design with the L-PAP flap represents one strategy in appropriate cases to overcome skin and volume deficiencies while facilitating coning and projection. Therapeutic, IV.
Identifiants
pubmed: 37010466
doi: 10.1097/PRS.0000000000010487
pii: 00006534-990000000-01717
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1005e-1010eInformations de copyright
Copyright © 2023 by the American Society of Plastic Surgeons.
Références
Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg. 2012;129:16e–23e.
Weitgasser L, Mahrhofer M, Schwaiger K, et al. Lessons learned from 30 years of transverse myocutaneous gracilis flap breast reconstruction: historical appraisal and review of the present literature and 300 cases. J Clin Med. 2021;10:3629.
Tuinder SMH, Beugels J, Lataster A, et al. The lateral thigh perforator flap for autologous breast reconstruction: a prospective analysis of 138 flaps. Plast Reconstr Surg. 2018;141:257–268.
Park JE, Alkureishi LWT, Song DH. TUGs into VUGs and friendly BUGs: transforming the gracilis territory into the best secondary breast reconstructive option. Plast Reconstr Surg. 2015;136:447–454.
Tessler O, Guste J, Bartow MJ, et al. Stacked lateral thigh perforator flap as a novel option for autologous breast reconstruction. Plast Reconstr Surg. 2019;143:1601–1604.
Haddock NT, Suszynski TM, Teotia SS. Consecutive bilateral breast reconstruction using stacked abdominally based and posterior thigh free flaps. Plast Reconstr Surg. 2021;147:294–303.
Haddock NT, Cho MJ, Teotia SS. Comparative analysis of single versus stacked free flap breast reconstruction: a single-center experience. Plast Reconstr Surg. 2019;144:369e–377e.
Largo RD, Chu CK, Chang EI, et al. Perforator mapping of the profunda artery perforator flap: anatomy and clinical experience. Plast Reconstr Surg. 2020;146:1135–1145.
Skochdopole AJ, Mentz JA, Gravina P, Winocour SJ, Reece EM. Maximizing volume from the medial thigh: introducing the PUG flap. Plast Reconstr Surg. 2021;148:329e–331e.
Ciudad P, Maruccia M, Orfaniotis G, et al. The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction. Microsurgery 2016;36:359–366.
Kolker AR, Xipoleas GD. The circumferential thigh lift and vertical extension circumferential thigh lift: maximizing aesthetics and safety in lower extremity contouring. Ann Plast Surg. 2011;66:452–456.
Gusenoff JA, Coon D, Nayar H, Kling RE, Rubin JP. Medial thigh lift in the massive weight loss population: outcomes and complications. Plast Reconstr Surg. 2015;135:98–106.
Chang EI, Kronowitz SJ. Dual-pedicle flap for unilateral autologous breast reconstruction revisited: evolution and optimization of flap design over 15 years. Plast Reconstr Surg. 2016;137:1372–1380.