title: The combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for breast reconstruction.
abstract: Surgical options for breast reconstruction include alloplastic and autogenous reconstructions. In autologous cases where the abdomen is not a suitable primary donor site, secondary donor sites such as the thigh or buttock are considered. The aim of this report is to describe a novel approach, the combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap, aimed at medium to large volume breast reconstruction, with a single donor site used per breast.
  
  
  
  Between January 2011 and June 2013, 32 consecutive unilateral immediate breast reconstruction cases were performed using free flaps. In nine cases, patients had previously undergone abdominal surgery, therefore abdominal flaps were excluded and TUGPAP flaps were performed. The TUGPAP flap consisted of the combination of two well-described flaps: the transverse upper gracilis (TUG) and the profunda artery perforator (PAP) flap. All TUGPAP flaps were based on two pedicles: the ascending branch of the medial circumflex femoral artery (MCFA) for the TUG component, and the profunda artery perforator itself for the PAP component.
  
  
  
  The mean size of the harvested skin paddle was 28.6 × 8 cm2(range, 27 × 7 cm2to 30 × 9 cm2). The average length of the TUG flap pedicle was 7 cm (range, 6-8 cm) and the PAP flap pedicle was 9 cm (range, 8.5-10 cm). The flap survival rate was 100% with no re-exploration, and no partial flap loss. Post-operatively there was one case of persistent donor site seroma, which was managed conservatively.
  
  
  
  With appropriate patient selection and surgical technique the TUGPAP flap could be a valuable option as an alternative method for autologous breast reconstruction. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.|PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan.|Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ciudad
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.|Department of Plastic Surgery, Reconstructive and Aesthetic Surgery, 'Sapienza' University, Rome, Italy, IN.
authors.forename: Michele
authors.initials: M
authors.lastname: Maruccia
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Georgios
authors.initials: G
authors.lastname: Orfaniotis
authors.affiliation: Institute of Gerontology, College Of Medicine, Cheng Kung Kung University, Tainan, Taiwan.
authors.forename: Hui-Ching
authors.initials: HC
authors.lastname: Weng
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Thomas
authors.initials: T
authors.lastname: Constantinescu
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Fabio
authors.initials: F
authors.lastname: Nicoli
authors.affiliation: Department of Plastic Surgery, Reconstructive and Aesthetic Surgery, 'Sapienza' University, Rome, Italy, IN.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cigna
authors.affiliation: Department of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Socas
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Pornthep
authors.initials: P
authors.lastname: Sirimahachaiyakul
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Stamatis
authors.initials: S
authors.lastname: Sapountzis
authors.affiliation: Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Kidakorn
authors.initials: K
authors.lastname: Kiranantawat
authors.affiliation: Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Shu-Ping
authors.initials: SP
authors.lastname: Lin
authors.affiliation: PhD Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan.|Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Gou-Jen
authors.initials: GJ
authors.lastname: Wang
authors.affiliation: Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen