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J Reconstr Microsurg 2020; 36(09): 645-650
DOI: 10.1055/s-0040-1713599
Original Article

Estimation of Profunda Artery Perforator Flap Weight Using Preoperative Computed Tomography Angiography

Nicolas Greige 
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
David Nash
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Ara A. Salibian
2   Department of Plastic Surgery, NYU Langone Health, Hansjörg Wyss, New York, New York
,
Steven M. Sultan
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Joseph A. Ricci
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Vishal D. Thanik
2   Department of Plastic Surgery, NYU Langone Health, Hansjörg Wyss, New York, New York
,
Katie E. Weichman
1   Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
› Author Affiliations Funding This research was supported by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number TL1TR001072.
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Abstract

Background Given the relatively small size of thigh-based flaps and the possible necessity for a multiflap reconstruction, it is imperative to arrive at an accurate estimation of flap weight during preoperative planning. It was our objective to develop a novel technique for the preoperative estimation of profunda artery perforator (PAP) flap weight.

Methods All patients that underwent transverse PAP flap breast reconstruction at two institutions were retrospectively reviewed. Subcutaneous tissue thicknesses were measured on axial computed tomography angiography scans at several predetermined points. The distance from the inferior gluteal crease to the PAP was also recorded. Linear regression was used to estimate flap weight.

Results A total of 18 patients (32 flaps) were analyzed. The median intraoperative flap weight was 299 g (interquartile range [IQR]: 235–408). The parsimonious model (R 2 = 0.80) estimated flap weight using the Eq. 77.9x + 33.8y + 43.4z – 254.3, where x is subcutaneous tissue thickness (cm) at the lateral border of long head of the biceps femoris at a level 4.5 cm caudal to the inferior gluteal fold, y is distance (cm) from the inferior gluteal fold to the dominant PAP, and z has a value of 1 if the patient was scanned in the supine position or 0 if prone. The aforementioned formula yielded a median estimated flap weight of 305 g (IQR: 234–402) and a median percent error of 10.5% (IQR: 6.1–16.2).

Conclusion The authors demonstrate a simple and accurate formula for the preoperative estimation of transverse PAP flap weight for breast reconstruction.

Keywords

PAP flap - flap weight estimation - predictive model

Note

This study was presented at American Society for Reconstructive Microsurgery Annual Meeting, Ft. Lauderdale, FL, January 10–14, 2020.




Publication History

Received: 01 February 2020

Accepted: 17 May 2020

Article published online:
24 June 2020

© 2020. Thieme. All rights reserved.

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