A Newly Described, Highly Prevalent Arterial Pedicle Perfuses Both Gracilis and Profunda Artery Perforator Flap Tissues: An Angiographic Study of the Medial Thigh
16 May 2019
27 August 2019
16 October 2019 (online)
Background Novel secondary flap options are paramount for patients who are not candidates for common reconstructive methods. The purpose of this study is to identify the prevalence of single arterial pedicle supplying both the gracilis muscle and medial thigh tissue carried in a profunda artery perforator (PAP) flap. Such a pedicle could allow the creation of a chimeric gracilis and PAP flap with a single-arterial anastomosis.
Methods We conducted a retrospective review of 157 lower extremity computed tomography (CT) angiograms to assess the vasculature of the thigh soft tissues. Imaging evaluation was supervised by a board-certified musculoskeletal radiologist.
Results Prevalence of a single-arterial pedicle to a gracilis and PAP flap in each patient was 59% (31% within the right leg and 28% in the left leg). Furthermore, 16% of patients had a common arterial pedicle in both lower extremities.
Conclusion Existence of a single-arterial pedicle to both the gracilis muscle and PAP flap tissues is frequently present in most patients in at least one lower extremity. This chimeric flap configuration could serve as a reconstructive avenue for patients, particularly those who have exhausted other more common flap options. Screening angiography is warranted in patients looking for this anatomic variation to establish its presence.
- 1 Vega SJ, Sandeen SN, Bossert RP, Perrone A, Ortiz L, Herrera H. Gracilis myocutaneous free flap in autologous breast reconstruction. Plast Reconstr Surg 2009; 124 (05) 1400-1409
- 2 Del Frari B, Schoeller T, Wechselberger G. Reconstruction of large head and neck deformities: experience with free gracilis muscle and myocutaneous flaps. Microsurgery 2010; 30 (03) 192-198
- 3 Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg 2006; 117 (07) 151e-160e
- 4 Kappler UA, Constantinescu MA, Büchler U, Vögelin E. Anatomy of the proximal cutaneous perforator vessels of the gracilis muscle. Br J Plast Surg 2005; 58 (04) 445-448
- 5 Peek A, Müller M, Ackermann G, Exner K, Baumeister S. The free gracilis perforator flap: anatomical study and clinical refinements of a new perforator flap. Plast Reconstr Surg 2009; 123 (02) 578-588
- 6 Dayan JH, Allen Jr RJ. Lower extremity free flaps for breast reconstruction. Plast Reconstr Surg 2017; 140 (5S Advances in Breast Reconstruction, 5S): 77S-86S
- 7 Haddock N, Nagarkar P, Teotia SS. Versatility of the profunda artery perforator flap: creative uses in breast reconstruction. Plast Reconstr Surg 2017; 139 (03) 606e-612e
- 8 Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg 2012; 129 (01) 16e-23e
- 9 Momeni A, Kovach SJ. Important considerations in chest wall reconstruction. J Surg Oncol 2016; 113 (08) 913-922
- 10 Bakri K, Mardini S, Evans KK, Carlsen BT, Arnold PG. Workhorse flaps in chest wall reconstruction: the pectoralis major, latissimus dorsi, and rectus abdominis flaps. Semin Plast Surg 2011; 25 (01) 43-54
- 11 Villa MT, Chang DW. Muscle and omental flaps for chest wall reconstruction. Thorac Surg Clin 2010; 20 (04) 543-550
- 12 Guerra AB, Metzinger SE, Lund KM, Cooper MM, Allen RJ, Dupin CL. The thoracodorsal artery perforator flap: clinical experience and anatomic study with emphasis on harvest techniques. Plast Reconstr Surg 2004; 114 (01) 32-41 , discussion 42–43
- 13 Lawson BR, Moreno MA. Head and neck reconstruction with chimeric anterolateral thigh free flap: indications, outcomes, and technical considerations. Otolaryngol Head Neck Surg 2016; 154 (01) 59-65
- 14 Stalder MW, Wise MW, Dupin CL, St Hilaire H. Versatility of subscapular chimeric free flaps in the secondary reconstruction of composite posttraumatic defects of the upper face. Craniomaxillofac Trauma Reconstr 2015; 8 (01) 42-49
- 15 Tomlinson AR, Jameson MJ, Pagedar NA, Schoeff SS, Shearer AE, Boyd NH. Use of the teres major muscle in chimeric subscapular system free flaps for head and neck reconstruction. JAMA Otolaryngol Head Neck Surg 2015; 141 (09) 816-821
- 16 Lin YT, Lin CH, Wei FC. More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2006; 59 (06) 622-627
- 17 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 (05) 359-366
- 18 Huang WC, Chen HC, Wei FC, Cheng MH, Schnur DP. Chimeric flap in clinical use. Clin Plast Surg 2003; 30 (03) 457-467
- 19 Garvey PB, Selber JC, Madewell JE, Bidaut L, Feng L, Yu P. A prospective study of preoperative computed tomographic angiography for head and neck reconstruction with anterolateral thigh flaps. Plast Reconstr Surg 2011; 127 (04) 1505-1514
- 20 Offodile II AC, Chatterjee A, Vallejo S, Fisher CS, Tchou JC, Guo L. A cost-utility analysis of the use of preoperative computed tomographic angiography in abdomen-based perforator flap breast reconstruction. Plast Reconstr Surg 2015; 135 (04) 662e-669e