BACKGROUND: The profunda artery perforator (PAP) flap is a well-known free flap for breast reconstruction. However, a reproducible perforator mapping system has yet to be developed.

METHODS: The PAP perforators were localized by CTA using a novel X-Y axis system. Flap dimensions were based on the CTA images and localized PAP-perforators. Perioperative findings and postoperative outcomes were analyzed.

RESULTS: A total of 70 lower limbs and 180 PAP perforators were evaluated. An average of 2.78 ± 1.22 and 2.22 ± 0.96 perforators were seen, in the right and left legs, respectively, and were divided in five clusters (PAP1-PAP5) based on their location on the Y-axis. The course of the perforators was noted as well as the average diameter at the origin. The overall average diameter was 1.99 ± 0.86 mm. A banana-shaped PAP-flap was harvested in 10 patients. The mean operative time was 278 min, pedicle length 76 ± 12 mm, and mean flap weight 247 g. No major complications were seen.

CONCLUSION: The PAP flap can be mapped by CTA in a reproducible way. The X and Y axes are based on fixed anatomic landmarks and may form the basis for a banana-shaped flap design of the PAP-flap.

Original languageEnglish
Pages (from-to)123-133
Number of pages11
JournalJournal of Surgical Oncology
Issue number2
Early online date2021
Publication statusPublished - Feb 2022

Bibliographical note

© 2021 Wiley Periodicals LLC.


  • autologous transplantation
  • breast reconstruction
  • computed tomography
  • free tissue flaps
  • perforator flap
  • thigh


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