The Anatomical Basis of the Profunda Femoris Artery Perforator (PAP) Flap: A New Option for Autologous Breast Reconstruction

The profunda femoris artery perforator (PAP) flap is an alternative for autologous breast reconstruction when abdominal tissue is not available. This flap is based on a perforator of the profunda femoris artery. The perforator is consistently found on cadaveric and Computer Tomography Angiogram (CTA). By cadaveric dissection the perforator was identified on average 3.5 centimeters (cm) inferior to the gluteal crease and 6.2 cm from the midline. The average pedicle length was 10.6 cm. Diameters of the artery and vein averaged 2.3 and 2.8 mm. The flaps averaged 28 × 8 cm and weighed about 200 g. On CTA the perforator was identified on average 4.4 cm caudal to the gluteal crease and 5.1 cm lateral to the midline. The consistent anatomy of the perforator allows for consistent elevation of the flap for free tissue transfer in breast reconstruction.