Determining the best recipient vessel site for autologous microsurgical breast reconstruction using PAP flaps: An anatomical study.

Abstract

Since its first description in 2012, the profunda femoris artery perforator (PAP) flap has gained increasing popularity and has progressively become the second-line option for autologous breast reconstruction. As with the deep inferior epigastric artery perforator (DIEP) flap, several recipient vascular pedicles, including the internal thoracic, thoracodorsal, and circumflex scapular pedicles, have been described for microvascular anastomoses. The aim of this anatomical observational study was to identify the optimal recipient site for PAP flap by determining the best donor-recipient vessel diameter match among these three potential pedicles. This study was based on 100 dissections of the three anatomical regions of interest, performed bilaterally in 50 fresh female cadavers. The internal vessel diameters were measured using a vascular gauge ranging from 1.0 to 5.0 mm, with successive 0.5-mm graduations. The median diameter of the PAP, internal thoracic (ITA), circumflex scapular (CSA) and thoracodorsal (TDA) arteries were: 2.0, 2.5, 2.5, and 2.0 mm, respectively. The median diameter of profunda femoris pedicle perforator (PVP), internal thoracic (ITV), circumflex scapular (CSV), and thoracodorsal (TDV) veins were: 3.0, 2.5, 3.0, and 2.5 mm, respectively. At the individual level, a perfect match between PAP and TDA was significantly more frequent than between PAP and CSA (p = 0.037), whereas no significant difference was observed between PAP and ITA compared with either PAP and TDA or PAP and CSA. For the venous system, a perfect match between PVP and CSV was significantly more frequent than that between PVP and ITV (p= 0.0088); however, no significant differences were found between PVP and ITV compared with PVP and TDV or between PVP and CSV compared with PVP and TDV. This study supports the thoracodorsal artery and circumflex scapular veins as the preferred recipient vessels, which, from an anatomical standpoint, provide the closest diameter match with the donor pedicles.