From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2024 Oct 1;154(4):632e-640e. doi: 10.1097/PRS.0000000000011052. Epub 2023 Sep 12.
Autologous tissue is the only permanent option for breast reconstruction. Whereas abdominal tissue remains popular, considering alternative donor sites ensures comprehensive care tailored to a patient. The thigh has been established as an excellent choice in autologous reconstruction. The authors present a 10-year experience with 405 profunda artery perforator (PAP) flaps.
An institutional review board-approved 10-year retrospective review of all patients treated with PAP flaps for breast reconstruction was performed. Procedures were carried out by 2 surgeons at the same institution. PAP flaps were divided into 4 consecutive groups with approximately 100 flaps in each group. Demographics, indications, intraoperative data, postoperative complications, revisions, and patient-reported outcomes were recorded and analyzed.
A total of 207 patients (405 PAP flaps) were included. This accounted for 17.2% of all breast reconstruction flaps. A total of 55% of patients underwent a multiflap procedure. The average flap weight was 354.3 g (±117.2), which decreased significantly over time ( P < 0.001). Rates of major complications were 9.6% wounds, 4.4% seromas, 4.7% hematomas, and 3.5% infections. Total flap loss was 2%, 67% of which were in stacked cases. Satisfaction routinely improved from before to after surgery.
As available flap donor sites continue to evolve, tailoring breast reconstruction to the individual patient is standard in centers of excellence. The PAP flap has emerged as an excellent choice for autologous-based breast reconstruction through use of proper patient selection and surgical technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
自体组织是乳房重建的唯一永久性选择。虽然腹部组织仍然很受欢迎，但考虑到替代供体部位可以确保为患者提供全面的个性化护理。大腿已经成为自体重建的绝佳选择。作者介绍了一项使用 405 个深动脉穿支（PAP）皮瓣的 10 年经验。
对在同一家机构接受 PAP 皮瓣乳房重建的所有患者进行了机构审查委员会批准的 10 年回顾性研究。手术由 2 位外科医生进行。将 PAP 皮瓣分为 4 个连续组，每组约 100 个皮瓣。记录并分析了人口统计学、适应证、术中数据、术后并发症、修复和患者报告的结果。
共纳入 207 例患者（405 个 PAP 皮瓣），占乳房重建皮瓣的 17.2%。共有 55%的患者接受了多瓣手术。平均皮瓣重量为 354.3g（±117.2），随时间显著下降（P<0.001）。主要并发症发生率为伤口 9.6%、血清肿 4.4%、血肿 4.7%和感染 3.5%。总皮瓣失活率为 2%，其中 67%发生在堆叠病例中。术后患者满意度普遍提高。
随着可用皮瓣供体部位的不断发展，为卓越中心的每位患者量身定制乳房重建已成为标准。PAP 皮瓣已成为自体乳房重建的绝佳选择，这得益于对患者的正确选择和手术技术。
临床问题/证据水平：治疗性，IV。
