The Superthin Profunda Artery Perforator Flap for Extremity Reconstruction: Clinical Implications

The profunda artery perforator flap has numerous advantages. For coverage of extremity wounds, however, traditional subfascial harvest results in a thick flap, which routinely requires secondary thinning. The author describes his approach and experience with thin and superthin profunda artery perforator flaps for extremity reconstruction. With preoperative perforator localization via computed tomography angiogram, color Doppler, and handheld Doppler, the author used a single dominant perforator for extremity reconstruction in 10 consecutive patients. The mean age of patients who had a thin or superthin profunda artery perforator flap for extremity reconstruction was 41.2 +/- 21.3 years. Flaps were used to cover wounds in the upper (n = 3) and lower (n = 7) extremities. Mean flap thickness was 0.7 +/- 0.2 cm. Mean flap artery diameter was 16 +/- 3 mm; mean flap vein diameter was 21 +/- 6 mm. Mean pedicle length was 6.8 +/- 1.2 cm. The difference between the actual measured intraoperative proximal-distal distance and the preoperative computed tomography angiogram measurement for each patient was calculated, with a mean difference of 1.2 +/- 0.6 cm. Advantages of the profunda artery perforator flap include a concealed donor site, large perforator caliber, long pedicle length, and a straightforward perforator dissection. Intraoperative measurement of the proximal-distal distance of the dominant perforator fell within 2 cm of the preoperative computed tomography angiogram measurement in all cases. The thin and superthin profunda artery perforator flaps provide new reconstructive options, particularly suited for use in the extremities.