Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review

Abstract

Background: Thigh-based flaps are generally considered a secondary option for breast reconstruction, with inner thigh-based transverse upper gracilis (TUG) flaps being the preferred choice for many surgeons; however, its well-established drawbacks include short pedicle length, lack of volume, and donor morbidity. The posterior thigh-based profunda femoris artery perforator (PAP) flap was introduced as an alternative approach, but these flaps were not comparatively analyzed with TUG flaps on a large scale. We aimed to systematically review TUG- and PAP-flap breast reconstruction to determine the better secondary option.

Methods: We performed a systematic review of the literature using the PubMed database. Our selected series for systematic analyses included 613 TUG flaps in 432 patients and 475 PAP flaps in 329 patients. Elementary data on the flaps and complications were collected and analyzed. Pooled estimates of proportions of flaps with recipient complications and donor site morbidity were compared using random effect single arm meta-analysis.

Results: The basic patient demographics were comparable between the flap types. The mean operation time was comparable. The PAP flap had longer pedicle length and higher flap weight. The total loss (p = .6579), partial loss rate (p = .3247), and fat necrosis rate (p = .0771) were comparable between flap types. Regarding donor morbidity, the PAP flap group had less wound dehiscence (p < .0001) and lower rate of sensory disturbance (p < .0001).

Conclusions: The study findings indicate that the PAP flap, when compared with the TUG flap, could be a better secondary option for breast reconstructions.