Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Microsurgery. 2023 Jul;43(5):444-451. doi: 10.1002/micr.30974. Epub 2022 Oct 7.
The profunda artery perforator (PAP) flap is a reliable alternative for autologous breast reconstruction; however, the amount of tissue provided is quite limited. For medium to large sized breast reconstruction two PAP flaps can be harvested and inset in "stacked" fashion. This procedure consists in placing the two flaps side by side, normally supplied by antegrade and retrograde anastomoses performed with the mammary vessels. In the present article, we report the employment of stacked PAP flaps with intra-flap anastomosis in breast reconstruction setting.
From April 2018 to December 2021, seven patients received unilateral breast reconstruction with stacked PAP flaps. Patients' average age was 47.5 (range 39-58 years old). Mean body mass index was 19.4 kg/m (range 18.5-20.1 kg/m ). The two flaps were linked by means of intra-flap anastomosis resorting to side branches of one of the two pedicles. In all cases the internal mammary vessels were dissected sparing the ribs and used as recipient vessels for antegrade end-to-end anastomosis.
The flaps size ranged from 15 cm × 6 cm to 20 cm × 7 cm with an average weight of 250 g (range 190-290 g). The mean pedicle length was 11.1 cm (range 10-12.5 cm) on the left side and 7.9 cm (range 7-9 cm) on the right side. All flaps survived completely after surgery. The donor sites were all primarily closed with no morbidities. The mean follow-up was 8 months (range 6-12 months). All patients were satisfied with the result.
Stacked PAP flaps performed with intra-flap anastomosis may represent a valid alternative solution for the reconstruction of moderate to large breast in case of unavailable abdominal tissue.
深穿支皮瓣（PAP 皮瓣）是自体乳房重建的可靠选择；然而，提供的组织量相当有限。对于中到大乳房重建，可以采集两个 PAP 皮瓣，并以“堆叠”的方式插入。该手术包括将两个皮瓣并排放置，通常通过乳腺血管的顺行和逆行吻合来供应。在本文中，我们报告了在乳房重建中使用带有皮瓣内吻合的堆叠 PAP 皮瓣。
从 2018 年 4 月至 2021 年 12 月，7 名患者接受了单侧乳房重建，使用堆叠的 PAP 皮瓣。患者平均年龄为 47.5 岁（范围 39-58 岁）。平均体重指数为 19.4kg/m²（范围 18.5-20.1kg/m²）。两个皮瓣通过其中一个蒂的侧支进行皮瓣内吻合连接。在所有情况下，都解剖了内乳血管，避免了肋骨，并将其用作顺行端端吻合的受体血管。
皮瓣大小从 15cm×6cm 到 20cm×7cm 不等，平均重量为 250g（范围 190-290g）。左侧蒂的平均长度为 11.1cm（范围 10-12.5cm），右侧为 7.9cm（范围 7-9cm）。手术后所有皮瓣完全存活。供区均一期直接缝合，无并发症。平均随访时间为 8 个月（范围 6-12 个月）。所有患者均对结果满意。
在无法获得腹部组织的情况下，带有皮瓣内吻合的堆叠 PAP 皮瓣可能是中到大乳房重建的有效替代方案。
