Use of the Profunda Femoris Artery Perforator Flap for Reconstruction after Sarcoma Resection

Abstract

Soft tissue sarcomas are rare neoplasms that can occur on any part of the body. The operative position for the resection is determined depending on the site of the soft tissue sarcomas; intraoperative repositioning may be needed for reconstruction. We present the profunda femoris artery perforator (PAP) flap harvest technique (wherein the flap can be used in any position), and suggest that the PAP flap transfer can eliminate the need for intraoperative repositioning.

Methods: From December 2018 to January 2020, 7 patients with an average age of 68 years underwent reconstructions using a PAP flap after wide resection of STS. The mean defect size was 11.3 × 16.5 cm (range, 5.5-25 × 11-26 cm). The location of the defects was the medial thigh in 2 patients, the posterior thigh in 1, the popliteal fossa in 1, the groin in 1, and the buttock in 2. The PAP flap was elevated in the supine "frog-leg" position, the prone position, the jack-knife position, or the lateral "crisscross" position; the lateral decubitus position with the donor lower extremity on the bottom.

Results: Of the 7 cases, the operations were performed in the supine "frog-leg" position in 3 cases, the prone position in 2 cases, the jack-knife position in 1 case, and the lateral "crisscross" position in 1 case. There were no intraoperative position changes in all cases. The mean size of the PAP flap was 8.7 × 19.9 cm (range, 6-11 × 17-24 cm). One patient had donor site dehiscence, which was treated conservatively. The PAP flaps survived completely in all cases. The mean follow-up period was 10.5 months (range, 6-17 months).

Conclusion: Since the PAP flap elevation is feasible in every position, the PAP flap can be considered a versatile reconstruction option after sarcoma resection.

Fig. 1.

Supine frog-leg position for PAP flap elevation. The supine position with the donor leg abducted and external rotated at the hip joint and flexed at the knee joint.

Fig. 2.

Prone position for PAP flap elevation. The prone position with the legs slightly abducted at the hip joint and extended at the knee joint.

Fig. 3.

Lateral crisscross position for PAP flap elevation. The lateral “crisscross” position; the lateral decubitus position with the donor lower extremity on the bottom. The donor leg is slightly flexed at the knee joint. The other leg is further flexed at the hip and lies parallel to the donor leg.

Fig. 4.

A 77-year-old man suffered from a soft tissue sarcoma on the left posterior thigh. A, Preoperative view. B, Intraoperative view after surgical wide resection. The defect after tumor ablation was 13 × 16 cm. C, Intraoperative view after microsurgical anastomosis. The pedicle of the PAP flap were anastomosed to the profunda femoris artery perforator and its vena comitans.

Fig. 5.

A 77-year-old man suffered from a soft tissue sarcoma on the left posterior thigh. A, Intraoperative view after flap inset. B, Postoperative view at 3 months after the surgery.

Fig. 6.

A 63-year-old woman suffered from a large soft tissue sarcoma on the right buttock. A, Preoperative view. B, Intraoperative view after surgical wide resection. The defect after tumor ablation was 25 × 26 cm.

Fig. 7.

A 63-year-old woman suffered from a large soft tissue sarcoma on the right buttock. A, Intraoperative view after flap inset. Yellow arrow: lumbar artery perforator flap; blue arrow: ALT flap; red arrow: PAP flap. B, Postoperative view at 6 months after the surgery.