New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, NY, USA.
Microsurgery. 2012 Oct;32(7):507-11. doi: 10.1002/micr.21980. Epub 2012 Mar 31.
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.
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.
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.
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.
股深动脉穿支（PAP）皮瓣是我们重建武器库中的一项新进展。为了更好地了解患者接受 PAP 皮瓣的情况，我们对术前影像学中的股深动脉穿支进行了特征描述。
四名整形外科医生对 40 例术前大腿后侧 CT 血管造影和磁共振血管造影进行了回顾性分析。记录患者的体位、检查类型、穿支数量和穿支大小。将位置记录在 x-y 轴上。记录穿支走行和周围肌肉情况。
在 98.8%的适合股深动脉穿支的大腿后区中均识别出了穿支。平均穿支数量和大小为 3.3 毫米和 1.9 毫米。最常见的穿支为内侧（85.6%的大腿存在）；位于大收肌附近，距中线 3.8 厘米，臀褶下 5.0 厘米处。第二常见的穿支为外侧（65.4%的大腿存在）；位于股二头肌和股外侧肌附近，距中线 12.0 厘米，臀褶下 5.0 厘米处。近 48.3%的穿支为纯皮穿支，51.7%的穿支有肌内走行（平均长度 5.7 厘米）。所有 PAP 皮瓣的解剖均证实术前影像学上存在合适的穿支。35 例 PAP 皮瓣（18 例患者）均存活，存活率为 100%。
对术前大腿后侧影像学的分析证实了我们在术中的发现，即存在大量合适的股深动脉后穿支，它们从筋膜中以一种常见的模式穿出，并具有足够的口径，以提供足够的皮瓣灌注和受区血管大小匹配。
