Download PDF
J Reconstr Microsurg 2020; 36(09): 645-650
DOI: 10.1055/s-0040-1713599
Original Article

Estimation of Profunda Artery Perforator Flap Weight Using Preoperative Computed Tomography Angiography

Nicolas Greige 
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
David Nash
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Ara A. Salibian
2   Department of Plastic Surgery, NYU Langone Health, Hansjörg Wyss, New York, New York
,
Steven M. Sultan
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Joseph A. Ricci
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Vishal D. Thanik
2   Department of Plastic Surgery, NYU Langone Health, Hansjörg Wyss, New York, New York
,
Katie E. Weichman
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
› Author Affiliations Funding This research was supported by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number TL1TR001072.
› Further Information
    Permissions and Reprints

Abstract

Background Given the relatively small size of thigh-based flaps and the possible necessity for a multiflap reconstruction, it is imperative to arrive at an accurate estimation of flap weight during preoperative planning. It was our objective to develop a novel technique for the preoperative estimation of profunda artery perforator (PAP) flap weight.

Methods All patients that underwent transverse PAP flap breast reconstruction at two institutions were retrospectively reviewed. Subcutaneous tissue thicknesses were measured on axial computed tomography angiography scans at several predetermined points. The distance from the inferior gluteal crease to the PAP was also recorded. Linear regression was used to estimate flap weight.

Results A total of 18 patients (32 flaps) were analyzed. The median intraoperative flap weight was 299 g (interquartile range [IQR]: 235–408). The parsimonious model (R 2 = 0.80) estimated flap weight using the Eq. 77.9x + 33.8y + 43.4z – 254.3, where x is subcutaneous tissue thickness (cm) at the lateral border of long head of the biceps femoris at a level 4.5 cm caudal to the inferior gluteal fold, y is distance (cm) from the inferior gluteal fold to the dominant PAP, and z has a value of 1 if the patient was scanned in the supine position or 0 if prone. The aforementioned formula yielded a median estimated flap weight of 305 g (IQR: 234–402) and a median percent error of 10.5% (IQR: 6.1–16.2).

Conclusion The authors demonstrate a simple and accurate formula for the preoperative estimation of transverse PAP flap weight for breast reconstruction.

Keywords

PAP flap - flap weight estimation - predictive model

Note

This study was presented at American Society for Reconstructive Microsurgery Annual Meeting, Ft. Lauderdale, FL, January 10–14, 2020.




Publication History

Received: 01 February 2020

Accepted: 17 May 2020

Article published online:
24 June 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Kamali P, Paul MA, Ibrahim AMS. , et al. National and regional differences in 32,248 postmastectomy autologous breast reconstruction using the updated national inpatient survey. Ann Plast Surg 2017; 78 (06) 717-722
    CrossrefPubMedGoogle Scholar
  • 2 Allen RJ. Lateral Thigh Perforator Flap Live Surgery Performed. 13th International Course on Perforator Flaps. Mexico City, Mexico: 2010
    Google Scholar
  • 3 Dayan JH, Allen Jr RJ. Lower extremity free flaps for breast reconstruction. Plast Reconstr Surg 2017; 140 (5S Advances in Breast Reconstruction): 77S-86S
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Haddock NT, Gassman A, Cho MJ, Teotia SS. 101 Consecutive profunda artery perforator flaps in breast reconstruction: lessons learned with our early experience. Plast Reconstr Surg 2017; 140 (02) 229-239
    CrossrefPubMedGoogle Scholar
  • 6 Qian B, Xiong L, Li J. , et al. A systematic review and meta-analysis on microsurgical safety and efficacy of profunda artery perforator flap in breast reconstruction. J Oncol 2019; 2019: 9506720
    CrossrefPubMedGoogle Scholar
  • 7 Lam G, Weichman KE, Reavey PL. , et al. Analysis of flap weight and postoperative complications based on flap weight in patients undergoing microsurgical breast reconstruction. J Reconstr Microsurg 2017; 33 (03) 186-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Haddock NT, Cho MJ, Gassman A, Teotia SS. Stacked profunda artery perforator flap for breast reconstruction in failed or unavailable deep inferior epigastric perforator flap. Plast Reconstr Surg 2019; 143 (03) 488e-494e
    CrossrefPubMedGoogle Scholar
  • 9 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 (06) 1601-1604
    CrossrefPubMedGoogle Scholar
  • 10 Nanidis TG, Ridha H, Jallali N. The use of computed tomography for the estimation of DIEP flap weights in breast reconstruction: a simple mathematical formula. J Plast Reconstr Aesthet Surg 2014; 67 (10) 1352-1356
    CrossrefPubMedGoogle Scholar
  • 11 Woo KJ, Kim EJ, Lee KT, Mun GH. A novel method to estimate the weight of the DIEP flap in breast reconstruction: DIEP-W, a simple calculation formula using paraumbilical flap thickness. J Reconstr Microsurg 2016; 32 (07) 520-527
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Agrawal MD, Thimmappa ND, Vasile JV. , et al. Autologous breast reconstruction: preoperative magnetic resonance angiography for perforator flap vessel mapping. J Reconstr Microsurg 2015; 31 (01) 1-11
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Mohan AT, Zhu L, Sur YJ. , et al. Application of posterior thigh three-dimensional profunda artery perforator perforasomes in refining next-generation flap designs: transverse, vertical, and S-shaped profunda artery perforator flaps. Plast Reconstr Surg 2017; 139 (04) 834e-845e
    CrossrefPubMedGoogle Scholar
  • 14 Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap: a new option for autologous breast reconstruction--a cadaveric and computer tomography angiogram study. J Reconstr Microsurg 2012; 28 (06) 381-386
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Vasile JV, Levine JL. Magnetic resonance angiography in perforator flap breast reconstruction. Gland Surg 2016; 5 (02) 197-211
    PubMedGoogle Scholar
  • 16 Cho MJ, Teotia SS, Haddock NT. Classification and management of donor-site wound complications in the profunda artery perforator flap for breast reconstruction. J Reconstr Microsurg 2020; 36 (02) 110-115
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg 2012; 129 (01) 16e-23e
    CrossrefPubMedGoogle Scholar
  • 18 van der Pot WJ, Kreulen M, Melis P, Hage JJ. Specific volume of female subcutaneous abdominal tissue as a reference in autologous breast reconstruction. J Reconstr Microsurg 2010; 26 (03) 185-188
    Article in Thieme ConnectPubMedGoogle Scholar