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Facial Plastic and Reconstructive Surgery

(404) Profunda Artery Perforator Flap Head & Neck Reconstruction: Systematic Review

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Renita Wilson, BS

    Medical Student
    Mayo Clinic Alix School of Medicine
    Phoenix, Arizona, United States

    • Co-Author(s)

  • TC

    Taylor B. Cave, MD

    Resident Physician
    Department of Otolaryngology – Head & Neck Surgery, Mayo Clinic Arizona
    Phoenix, AZ, United States

  • Erin Ware, MLIS

    Medical Librarian
    Medical Library, LSU Health Shreveport
    Shreveport, Louisiana, United States

    • Senior Author(s)

  • BC

    Brent A. Chang, MD

    Assistant Professor
    Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic Arizona
    Phoenix, AZ, USA

Disclosure(s):
Renita Wilson, BS: No relevant relationships to disclose.
Erin Ware, MLIS: No relevant relationships to disclose.


Introduction: The musculocutaneous profunda artery perforator (PAP) flap has gained popularity as a reliable option for breast reconstruction but is yet to be widely applied in head and neck procedures. This systematic review highlights its utility and outcomes in head and neck reconstruction.

Methods: A systematic review of the English language literature was conducted for studies with at least three patients 18 years or older undergoing head and neck reconstruction utilizing the PAP. A comprehensive search of PUBMED, EMBASE, Web of Science, and Google Scholar (January 1948 – February 2022) was conducted. Included texts were analyzed for primary outcomes (partial or complete flap failure, donor site morbidity, procedural complications) and secondary outcomes (functional outcomes, comparison to other flaps, flap size, and recipient vasculature) along with patient demographics. The quality of the selected studies was assessed with the MINORS criteria.

Results: Out of 735 articles identified, nine met inclusion criteria (2 case series, 5 retrospective, and 2 prospective). A total of 206 flaps across 205 patients with mean age of 57.3 years were included. Flaps were performed primarily for oncologic and trauma reconstructions. Average flap size was 115.94 cm2 with a 99% success rate. Two flaps failed due to vasospasm and pedicle thrombosis. 16 flaps (7.77%) underwent subsequent revision procedures, with two requiring additional ALT flaps. 10 flaps (4.85%) were reported as partial flap failures due to necrosis from intraoral flap folding (2, 0.97%), partial necrosis (3, 1.46%), pedicle thrombosis (3, 1.46%), margin necrosis (1, 0.49%), and unspecified reasons (1, 0.49%). The overall surgical and medical complication rate was 33%. Quality assessment suggested moderate to high risk of bias in all studies.

Conclusions: Based on limited quality evidence in a small total patient population, the PAP flap appears to be a safe, feasible, and favorable option for various head and neck reconstruction procedures with a reasonable complication rate. Further research on this topic is warranted.