Expanding the applications of the combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for extensive defects

Pedro Ciudad, Tony Chieh Ting Huang, Oscar J. Manrique, Mouchammed Agko, Stamatis Sapountzis, Fabio Nicoli, M. Diya Sabbagh, Luis Parra Pont, Steven L. Moran, Hung Chi Chen

Research output: Contribution to journalArticle

Abstract

Background: The medial thigh is a well-hidden area. The two most common flaps from this area are the transverse upper gracilis (TUG) and profunda artery perforator (PAP) flaps. Herein, we explored the applications of combined TUGPAP flap to reconstruct large and complex defects in different regions. Methods: Between November 2015 and May 2017, 28 patients who underwent reconstruction and extensive soft tissue coverage with the TUGPAP flap for the breasts, head and neck, and pelvi-perineal regions were included. The defects size ranged from 22 to 29 × 6–8 cm. All flaps were based on the two pedicles: the medial circumflex femoral artery for TUG flap and the profunda artery perforator for PAP flap. They were each anastomosed to a set of recipient vessels. A “Y”-shaped interposition vein graft (YVG) was used if only one recipient artery was available. Results: The harvested skin paddle had dimensions ranged from 20 to 30 × 6–9 cm and all flaps survived completely. Postoperative complications included one case each of donor and recipient site seroma, and one case of wound dehiscence. They were all successfully managed conservatively. During an average follow-up period of 12.7 months, one patient reported permanent paresthesia in the donor site and another developed hypertrophic scar. All patients were able to resume daily activity without major concerns. Conclusion: The combined TUGPAP flap is a safe, effective, and a good alternative to the common workhorse flaps as it offers the potential for a large skin paddle and decent soft tissue volume with low donor site morbidity in a well-concealed area.

Original languageEnglish (US)
Pages (from-to)316-325
Number of pages10
JournalMicrosurgery
Volume39
Issue number4
DOIs
StatePublished - May 1 2019

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Perforator Flap
Arteries
Tissue Donors
Hypertrophic Cicatrix
Seroma
Skin
Paresthesia
Femoral Artery
Thigh
Veins
Breast
Neck
Head
Morbidity
Transplants
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

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Expanding the applications of the combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for extensive defects. / Ciudad, Pedro; Huang, Tony Chieh Ting; Manrique, Oscar J.; Agko, Mouchammed; Sapountzis, Stamatis; Nicoli, Fabio; Diya Sabbagh, M.; Pont, Luis Parra; Moran, Steven L.; Chen, Hung Chi.

In: Microsurgery, Vol. 39, No. 4, 01.05.2019, p. 316-325.

Research output: Contribution to journalArticle

Ciudad, P, Huang, TCT, Manrique, OJ, Agko, M, Sapountzis, S, Nicoli, F, Diya Sabbagh, M, Pont, LP, Moran, SL & Chen, HC 2019, 'Expanding the applications of the combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for extensive defects', Microsurgery, vol. 39, no. 4, pp. 316-325. https://doi.org/10.1002/micr.30413
Ciudad, Pedro ; Huang, Tony Chieh Ting ; Manrique, Oscar J. ; Agko, Mouchammed ; Sapountzis, Stamatis ; Nicoli, Fabio ; Diya Sabbagh, M. ; Pont, Luis Parra ; Moran, Steven L. ; Chen, Hung Chi. / Expanding the applications of the combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for extensive defects. In: Microsurgery. 2019 ; Vol. 39, No. 4. pp. 316-325.
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abstract = "Background: The medial thigh is a well-hidden area. The two most common flaps from this area are the transverse upper gracilis (TUG) and profunda artery perforator (PAP) flaps. Herein, we explored the applications of combined TUGPAP flap to reconstruct large and complex defects in different regions. Methods: Between November 2015 and May 2017, 28 patients who underwent reconstruction and extensive soft tissue coverage with the TUGPAP flap for the breasts, head and neck, and pelvi-perineal regions were included. The defects size ranged from 22 to 29 × 6–8 cm. All flaps were based on the two pedicles: the medial circumflex femoral artery for TUG flap and the profunda artery perforator for PAP flap. They were each anastomosed to a set of recipient vessels. A “Y”-shaped interposition vein graft (YVG) was used if only one recipient artery was available. Results: The harvested skin paddle had dimensions ranged from 20 to 30 × 6–9 cm and all flaps survived completely. Postoperative complications included one case each of donor and recipient site seroma, and one case of wound dehiscence. They were all successfully managed conservatively. During an average follow-up period of 12.7 months, one patient reported permanent paresthesia in the donor site and another developed hypertrophic scar. All patients were able to resume daily activity without major concerns. Conclusion: The combined TUGPAP flap is a safe, effective, and a good alternative to the common workhorse flaps as it offers the potential for a large skin paddle and decent soft tissue volume with low donor site morbidity in a well-concealed area.",
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AU - Ciudad, Pedro

AU - Huang, Tony Chieh Ting

AU - Manrique, Oscar J.

AU - Agko, Mouchammed

AU - Sapountzis, Stamatis

AU - Nicoli, Fabio

AU - Diya Sabbagh, M.

AU - Pont, Luis Parra

AU - Moran, Steven L.

AU - Chen, Hung Chi

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: The medial thigh is a well-hidden area. The two most common flaps from this area are the transverse upper gracilis (TUG) and profunda artery perforator (PAP) flaps. Herein, we explored the applications of combined TUGPAP flap to reconstruct large and complex defects in different regions. Methods: Between November 2015 and May 2017, 28 patients who underwent reconstruction and extensive soft tissue coverage with the TUGPAP flap for the breasts, head and neck, and pelvi-perineal regions were included. The defects size ranged from 22 to 29 × 6–8 cm. All flaps were based on the two pedicles: the medial circumflex femoral artery for TUG flap and the profunda artery perforator for PAP flap. They were each anastomosed to a set of recipient vessels. A “Y”-shaped interposition vein graft (YVG) was used if only one recipient artery was available. Results: The harvested skin paddle had dimensions ranged from 20 to 30 × 6–9 cm and all flaps survived completely. Postoperative complications included one case each of donor and recipient site seroma, and one case of wound dehiscence. They were all successfully managed conservatively. During an average follow-up period of 12.7 months, one patient reported permanent paresthesia in the donor site and another developed hypertrophic scar. All patients were able to resume daily activity without major concerns. Conclusion: The combined TUGPAP flap is a safe, effective, and a good alternative to the common workhorse flaps as it offers the potential for a large skin paddle and decent soft tissue volume with low donor site morbidity in a well-concealed area.

AB - Background: The medial thigh is a well-hidden area. The two most common flaps from this area are the transverse upper gracilis (TUG) and profunda artery perforator (PAP) flaps. Herein, we explored the applications of combined TUGPAP flap to reconstruct large and complex defects in different regions. Methods: Between November 2015 and May 2017, 28 patients who underwent reconstruction and extensive soft tissue coverage with the TUGPAP flap for the breasts, head and neck, and pelvi-perineal regions were included. The defects size ranged from 22 to 29 × 6–8 cm. All flaps were based on the two pedicles: the medial circumflex femoral artery for TUG flap and the profunda artery perforator for PAP flap. They were each anastomosed to a set of recipient vessels. A “Y”-shaped interposition vein graft (YVG) was used if only one recipient artery was available. Results: The harvested skin paddle had dimensions ranged from 20 to 30 × 6–9 cm and all flaps survived completely. Postoperative complications included one case each of donor and recipient site seroma, and one case of wound dehiscence. They were all successfully managed conservatively. During an average follow-up period of 12.7 months, one patient reported permanent paresthesia in the donor site and another developed hypertrophic scar. All patients were able to resume daily activity without major concerns. Conclusion: The combined TUGPAP flap is a safe, effective, and a good alternative to the common workhorse flaps as it offers the potential for a large skin paddle and decent soft tissue volume with low donor site morbidity in a well-concealed area.

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