title: Expanding the Applications of the Profunda Artery Perforator Flap.
abstract: BACKGROUND
  The profunda artery perforator free flap has not gained traction for nonbreast reconstruction, likely because of the presence of a proven workhorse in the anterolateral thigh flap. The authors believe that the profunda artery perforator flap offers similar coverage characteristics with the benefits of a medial donor site, a more consistent anatomy, and relatively easy dissection. The authors review their indications, technique, and outcomes in seven patients requiring eight free flap reconstructions.
  
  
  METHODS
  The authors applied the use of the vertically oriented profunda artery perforator flap to both lower extremity and head and neck reconstructions in which an anterolateral thigh flap would normally have been used. Details reviewed include soft-tissue defect, perforator location, flap size, recipient vessel, and complications.
  
  
  RESULTS
  Eight soft-tissue defects were covered with a vertically oriented profunda artery perforator flap in seven patients. Six reconstructions were for distal lower extremity and two were for head and neck reconstruction, both trauma and oncologic reconstructions. Flap sizes ranged from 40 to 92 cm. The pedicle length ranged from 7 to 10 cm. There were no partial or complete flap losses. One complication of seroma at the donor site requiring washout and closure was encountered.
  
  
  CONCLUSIONS
  The profunda artery perforator flap is a safe and effective option for perforator-based free flap reconstruction with relative ease of harvest and an inconspicuous donor site. This flap offers an excellent alternative to the anterolateral thigh flap. In certain patient demographics, the profunda artery perforator flap should be considered as a primary option.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: New Orleans, La. From the Division of Plastic and Reconstructive Surgery, Louisiana State University; and the Division of Plastic and Reconstructive Surgery, Tulane University.
authors.forename: James L
authors.initials: JL
authors.lastname: Mayo
authors.forename: Orlando
authors.initials: O
authors.lastname: Canizares
authors.forename: Radbeh
authors.initials: R
authors.lastname: Torabi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Allen
authors.forename: Hugo St
authors.initials: HS
authors.lastname: Hilaire
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply; D019651:Plastic Surgery Procedures / Q000379:methods*
references.citation: Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32:32–38
references.citation: Hidalgo DA. Fibula free flap: A new method of mandible reconstruction. Plast Reconstr Surg. 1989;84:71–79
references.citation: Haddock NT, Greaney P, Otterburn D, Levine S, Allen RJ. Predicting perforator location on preoperative imaging for the profunda artery perforator flap. Microsurgery. 2012;32:507–511
references.citation: 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;28:381–386
references.citation: Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg. 2012;129:16e–23e
references.citation: Angrigiani C, Grilli D, Thorne CH. The adductor flap: A new method for transferring posterior and medial thigh skin. Plast Reconstr Surg. 2001;107:1725–1731
references.citation: Sakai S, Shibata M. Free adductor perforator flap in lower leg reconstruction. J Plast Reconstr Aesthet Surg. 2006;59:990–993
references.citation: DeLong MR, Hughes DB, Bond JE, Thomas SM, Boll DT, Zenn MR. A detailed evaluation of the anatomical variations of the profunda artery perforator flap using computed tomographic angiograms. Plast Reconstr Surg. 2014;134:186e–192e
references.citation: Hupkens P, Ozturk E, Wittens S, Hoevenaren IA, Kooloos JG, Ulrich DJ. Posterior thigh perforator flaps: An anatomical study to localize and classify posterior thigh perforators. Microsurgery. 2013;33:376–382
references.citation: Hurwitz ZM, Montilla R, Dunn RM, Patel NV, Akyurek M. Adductor magnus perforator flap revisited: An anatomical review and clinical applications. Ann Plast Surg. 2011;66:438–443
references.citation: Rubin JA, Whetzel TP, Stevenson TR. The posterior thigh fasciocutaneous flap: Vascular anatomy and clinical application. Plast Reconstr Surg. 1995;95:1228–1239
references.citation: Kimata Y, Uchiyama K, Ebihara S, et al. Comparison of innervated and noninnervated free flaps in oral reconstruction. Plast Reconstr Surg. 1999;104:1307–1313
references.citation: Koshima I, Kawada S, Etoh H, Kawamura S, Moriguchi T, Sonoh H. Flow-through anterior thigh flaps for one-stage reconstruction of soft-tissue defects and revascularization of ischemic extremities. Plast Reconstr Surg. 1995;95:252–260
references.citation: Koshima I, Yamamoto H, Hosoda M, Moriguchi T, Orita Y, Nagayama H. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: An introduction to the chimeric flap principle. Plast Reconstr Surg. 1993;92:411–420
references.citation: Koshima I, Fukuda H, Soeda S. Free combined anterolateral thigh flap and vascularized iliac bone graft with double vascular pedicle. J Reconstr Microsurg. 1989;5:55–61
references.citation: Song YG, Chen GZ, Song YL. The free thigh flap: A new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984;37:149–159
references.citation: Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: A systematic review. Plast Reconstr Surg. 2012;130:1254–1268
references.citation: Collins J, Ayeni O, Thoma A. A systematic review of anterolateral thigh flap donor site morbidity. Can J Plast Surg. 2012;20:17–23
references.citation: Koshima I, Fukuda H, Utunomiya R, Soeda S. The anterolateral thigh flap; variations in its vascular pedicle. Br J Plast Surg. 1989;42:260–262