Distal profunda femoris artery perforator island flap for distal thigh and knee reconstruction: a CT‐based anatomical analysis and a case‐series study

Abstract

AbstractBackgroundLocoregional flap options for reconstructing defects of the anterolateral distal thigh/knee region are limited. The distal profunda artery perforator island (PAPI) flap is a local fasciocutaneous propeller‐type flap that utilizes the most distal perforator of the profunda femoris artery. The aim of this study is to conduct a CT‐based angiographic analysis of the perforator system of the profunda femoris artery and present outcomes on the application of the PAPI flap in the management of post‐oncologic defects of the distal thigh and knee.MethodsCT angiograms were utilized on the lower limbs of 25 healthy patients (mean age, 57 years; 76% male) and the number and location of septocutaneous perforators with a diameter greater than 1 mm were measured. A case series of patients undergoing reconstruction of post‐ablative defects which involved the anterolateral and posterior knee performed by the senior author were reviewed.ResultsCT angiography demonstrated a robust collection (mean 3.5, range 2 to 5) of septocutaneous perforators from the profunda femoris artery with the most distal perforator located 3.3 cm from the superior patella border. The PAPI flap was successfully used in 10 patients (6F; 4M; mean age 60.6 years; range 30 to 88 years) with a mean defect size of 87.5 cm2 (range 48 to 150 cm2). Hand‐held Doppler was used to detect the perforator. No flap loss was encountered, and no knee function limitation was noted at follow‐up. Minor complications include seroma (1) and intra‐articular infection (2).ConclusionsWe conclude that the distal PAPI flap is a reliable and versatile flap that has potentially wide applications.