J Reconstr Microsurg 2011; 27(9): 531-536
DOI: 10.1055/s-0031-1285991
© Thieme Medical Publishers

Deep Femoral Artery Perforator Flap: A New Perforator Flap for Breast Reconstruction

Lisa F. Schneider1 , Julie V. Vasile2 , Joshua L. Levine2 , Robert J. Allen1
  • 1Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York
  • 2Center for Microsurgical Breast Reconstruction, New York, New York
Further Information

Publication History

Publication Date:
09 August 2011 (online)

ABSTRACT

We present the deep femoral artery perforator (DFAP) flap, a new perforator flap for breast reconstruction, with a detailed description of operative technique and four clinical examples. The DFAP flap allows harvest of tissue from the lower buttock and lateral thigh with similar territory to an in-the-crease inferior gluteal artery perforator (IGAP) flap but based on a different perforator. When present, the DFAP is the largest vessel supplying this territory and is often septocutaneous, facilitating dissection when compared with the IGAP flap. We used preoperative imaging with magnetic resonance angiography to assist in accurate flap planning which also permitted precise determination of perforator origin. In patients with either a contraindication to abdominal wall-based perforator flaps or weight distribution below the waist, the DFAP flap provides an alternative to the IGAP flap with an excellent pedicle and a favorable location on the lateral thigh.

REFERENCES

  • 1 Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun M J. Cancer statistics, 2009.  CA Cancer J Clin. 2009;  59 (4) 225-249
  • 2 Katipamula R, Degnim A C, Hoskin T et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging.  J Clin Oncol. 2009;  27 (25) 4082-4088
  • 3 Katz S J, Lantz P M, Janz N K et al. Patient involvement in surgery treatment decisions for breast cancer.  J Clin Oncol. 2005;  23 (24) 5526-5533
  • 4 Lostumbo L, Carbine N, Wallace J, Ezzo J. Prophylactic mastectomy for the prevention of breast cancer.  Cochrane Database Syst Rev. 2004;  4 (4) CD002748
  • 5 Tuttle T M, Habermann E B, Grund E H, Morris T J, Virnig B A. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment.  J Clin Oncol. 2007;  25 (33) 5203-5209
  • 6 Beahm E K, Walton R L. Issues, considerations, and trends in bilateral breast reconstruction.  Plast Reconstr Surg. 2009;  124 (4) 1064-1076
  • 7 Hu E S, Pusic A L, Waljee J F et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period.  Plast Reconstr Surg. 2009;  124 (1) 1-8
  • 8 Nahabedian M Y, Momen B, Galdino G, Manson P N. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome.  Plast Reconstr Surg. 2002;  110 (2) 466-475 discussion 476-477
  • 9 Kroll S S, Sharma S, Koutz C et al. Postoperative morphine requirements of free TRAM and DIEP flaps.  Plast Reconstr Surg. 2001;  107 (2) 338-341
  • 10 Lee B T, Yueh J H, Chen C, Lin S J, Tobias A M, Slavin S A. Establishment of perforator flap programs for breast reconstruction: the New England program experience.  Plast Reconstr Surg. 2009;  124 (5) 1410-1418
  • 11 Levine J L, Miller Q, Vasile J et al. Simultaneous bilateral breast reconstruction with in-the-crease inferior gluteal artery perforator flaps.  Ann Plast Surg. 2009;  63 (3) 249-254
  • 12 Azim Jr H A, Santoro L, Pavlidis N et al. Safety of pregnancy following breast cancer diagnosis: a meta-analysis of 14 studies.  Eur J Cancer. 2011;  47 (1) 74-83
  • 13 Kaas R, Verhoef S, Wesseling J et al. Prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers: very low risk for subsequent breast cancer.  Ann Surg. 2010;  251 (3) 488-492
  • 14 Guerra A B, Metzinger S E, Bidros R S, Gill P S, Dupin C L, Allen R J. Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases.  Ann Plast Surg. 2004;  52 (2) 118-125
  • 15 Baker D C, Barton Jr F E, Converse J M. A combined biceps and semitendinosus muscle flap in the repair of ischial sores.  Br J Plast Surg. 1978;  31 (1) 26-28
  • 16 Song Y G, Chen G Z, Song Y L. The free thigh flap: a new free flap concept based on the septocutaneous artery.  Br J Plast Surg. 1984;  37 (2) 149-159
  • 17 Vasile J V, Newman T, Rusch D G et al. Anatomic imaging of gluteal perforator flaps without ionizing radiation: seeing is believing with magnetic resonance angiography.  J Reconstr Microsurg. 2010;  26 (1) 45-57
  • 18 Allen R J, Tucker Jr C. Superior gluteal artery perforator free flap for breast reconstruction.  Plast Reconstr Surg. 1995;  95 (7) 1207-1212
  • 19 Le-Quang C. [Secondary microsurgical reconstruction of the breast and free inferior gluteal flap].  Ann Chir Plast Esthet. 1992;  37 (6) 723-741
  • 20 Paletta C E, Bostwick III J, Nahai F. The inferior gluteal free flap in breast reconstruction.  Plast Reconstr Surg. 1989;  84 (6) 875-883 discussion 884-885
  • 21 Fujino T, Abe O, Enomoto K. Primary reconstruction of the breast by free myocutaneous gluteal flap.  Int Adv Surg Oncol. 1981;  4 127-143
  • 22 Allen R J, Levine J L, Granzow J W. The in-the-crease inferior gluteal artery perforator flap for breast reconstruction.  Plast Reconstr Surg. 2006;  118 (2) 333-339
  • 23 Rubin J A, Whetzel T P, Stevenson T R. The posterior thigh fasciocutaneous flap: vascular anatomy and clinical application.  Plast Reconstr Surg. 1995;  95 (7) 1228-1239
  • 24 Ahmadzadeh R, Bergeron L, Tang M, Geddes C R, Morris S F. The posterior thigh perforator flap or profunda femoris artery perforator flap.  Plast Reconstr Surg. 2007;  119 (1) 194-200 discussion 201-202

Lisa F SchneiderM.D. 

Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center

560 First Avenue, New York, NY 10016

Email: lisa.schneider@nyumc.org