Charlès Laura M, Dabi Yohann, Mernier Thibaud, Lellouch Alexandre G, Lantieri Laurent
Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Shriners Children's Boston, Boston, MA, United States; Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, Paris, France; Sorbonne Université, Paris, France.
Sorbonne Université - Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France.
J Plast Reconstr Aesthet Surg. 2025 Feb;101:141-149. doi: 10.1016/j.bjps.2024.11.040. Epub 2024 Nov 29.
Profunda artery perforator (PAP) flap following cancer surgery has emerged as a relevant alternative for breast reconstruction but is mainly used in cases where the deep inferior epigastric perforator (DIEP) flap cannot be performed. The aim of this study was to compare the PAP and DIEP flaps' surgical and aesthetics outcomes in breast reconstruction.
Women who underwent breast reconstruction by DIEP or PAP flap at the Plastic Surgery Department of Georges Pompidou European University Hospital, Paris, France, between January 2012 and December 2020 were included. Patient's demographic characteristics, type, laterality, and timing of reconstruction were recorded. Operative times, length of hospital stay, general complications, and surgical complications were compared. The number of late surgical reoperations, their timing relative to the initial reconstructive procedure, and their purpose were also compared.
A total of 677 patients were included, 559 of whom received DIEP flaps and 118 received PAP flaps. PAP flap patients were significantly younger, thinner, and had a smaller initial bra cup size than those who received DIEP (p < 0.001) Operative time was similar for both groups (p = 0.074). There was no difference in the number of early post-operative reoperations (p > 0.554) or late revisions (p > 0.403) between DIEP or PAP.
Provided that the technical and human resources are available, PAP flap is a valid technique, without increased risk of surgical complications and reoperations, or lengthening of operative time. The PAP flap should be considered a primary therapeutic option and not as an alternative to the DIEP flap.
癌症手术后的股深动脉穿支（PAP）皮瓣已成为乳房重建的一种相关替代方案，但主要用于无法进行腹壁下深动脉穿支（DIEP）皮瓣的情况。本研究的目的是比较PAP和DIEP皮瓣在乳房重建中的手术和美学效果。
纳入2012年1月至2020年12月在法国巴黎乔治·蓬皮杜欧洲大学医院整形外科接受DIEP或PAP皮瓣乳房重建的女性。记录患者的人口统计学特征、重建类型、患侧和时间。比较手术时间、住院时间、一般并发症和手术并发症。还比较了晚期手术再次手术的次数、相对于初始重建手术的时间及其目的。
共纳入677例患者，其中559例接受DIEP皮瓣，118例接受PAP皮瓣。接受PAP皮瓣的患者比接受DIEP皮瓣的患者明显更年轻、更瘦，初始胸罩罩杯尺寸更小（p<0.001）。两组的手术时间相似（p=0.074）。DIEP或PAP之间术后早期再次手术的次数（p>0.554）或晚期翻修的次数（p>0.403）没有差异。
如果有技术和人力资源，PAP皮瓣是一种有效的技术，不会增加手术并发症和再次手术的风险，也不会延长手术时间。PAP皮瓣应被视为主要的治疗选择，而不是DIEP皮瓣的替代方案。
