Superthin Profunda Artery Perforator Flap For Extremity Reconstruction: Radiological Analysis And Clinical Cases
Harvey Chim, MD.
University of Florida College of Medicine, Gainesville, FL, USA.
PURPOSE: For coverage of extremity wounds, traditional subfascial profunda artery perforator (PAP) flap harvest results in a flap which is too thick. The aim of this study was firstly to characterize the suprafascial perforator anatomy of profunda artery perforators on preoperative computed tomography angiography (CTA) and secondly to describe our approach and experience with the superthin PAP flap for extremity reconstruction.
METHODS: Suprafascial profunda artery perforator anatomy was reviewed in CTAs in 159 thighs. We describe our experience with superthin PAP flaps using a single dominant perforator, for extremity reconstruction in 20 consecutive patients.
RESULTS: Two main perforator patterns, a "T" (superficial bifurcation) and "Y" (deeper bifurcation) were identified. The ratio between the total skin thickness and the distance from the skin to the perforator bifurcation point and the total skin thickness was higher in the "T" perforator pattern. A dominant "T" perforator (n=97) was more common than "Y" (n=62). A dominant "T" perforator was more common in women and with higher body mass index (BMI). In the clinical study, we found an almost perfect correlation between skin thickness of the bifurcation point of a dominant "T" perforator and thickness of the superficial fascia where a superthin PAP flap is elevated.
CONCLUSION: A dominant "T" perforator on preoperative CTA accurately predicts thickness of a PAP flap elevated at the level of the superficial fascia. 
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