title: Predicting perforator location on preoperative imaging for the profunda artery perforator flap.
abstract: BACKGROUND
  The profunda artery perforator (PAP) flap is a new addition to our reconstructive armamentarium. In effort to better understand patient candidacy for the PAP flap we characterized the profunda artery perforators on preoperative imaging.
  
  
  METHODS
  A retrospective review was completed of 40 preoperative posterior thigh computed tomography angiographies and magnetic resonance angiographies by four plastic surgeons. The positioning of the patient, type of study, number of perforators, and size of perforators were documented. The location was documented on an x-y-axis. Perforator course and surrounding musculature was documented.
  
  
  RESULTS
  In 98.8% of posterior thighs suitable profunda artery perforators were identified. The average number and size of perforators was 3.3 and 1.9 mm. The most common perforator was medial (present in 85.6% of thighs); found near the adductor magnus at 3.8 cm from midline and 5.0 cm below the gluteal fold. The second most common perforator was lateral (present in 65.4% of thighs); found near the biceps femoris and vastus lateralis at 12.0 cm from midline and 5.0 cm below the gluteal fold. Nearly 48.3% were purely septocutaneous. And 51.7% had an intramuscular course (average length 5.7 cm). Preoperative imaging corresponded to suitable perforators at the time of dissection of all PAP flaps. Thirty five PAP flaps (18 patients) were performed with 100% flap survival.
  
  
  CONCLUSIONS
  Analysis of preoperative posterior thigh imaging confirms our intraoperative findings that a considerable number of suitable posterior thigh profunda perforators are present, emerge from the fascia in a common pattern, and are of sufficient caliber to provide adequate flap perfusion and recipient vessel size match.
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, NY, USA. haddockmd@gmail.com
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Haddock
authors.forename: Patrick
authors.initials: P
authors.lastname: Greaney
authors.forename: David
authors.initials: D
authors.lastname: Otterburn
authors.forename: Steve
authors.initials: S
authors.lastname: Levine
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
mesh_terms: D000328:Adult; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006085:Graft Survival; D006801:Humans; D018810:Magnetic Resonance Angiography; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D011300:Preoperative Care; D012189:Retrospective Studies; D013848:Thigh / Q000098:blood supply* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed