A case of using profunda artery perforator flap as an intraoperative salvage for failed deep inferior epigastric artery perforator flap harvesting in autologous breast reconstruction

On April 11, 2019, a 36-year-old female patient was admitted to Hunan Cancer Hospital. Five years after the modified radical mastectomy for right breast cancer, she planned to undergo scar releasing and reconstruction of right chest wall and free deep inferior epigastric artery perforator (DIEP) flap transfer, right breast reconstruction, and left breast mastopexy. The defect of right chest wall after scar resection was 18 cm×10 cm. During the operation, the vascular pedicle of DIEP flap was accidentally injured, then the profunda artery perforator flap in left inner thigh was designed for salvage. The size of the flap was 20 cm×11 cm, the thickness was 4.5 cm, the length of perforator vessel pedicle was 7.6 cm, and the weight of the flap was 360 g. The right breast defect was repaired with the transferred flap and the deep cavity was filled. The vascular pedicle of profunda artery was anastomosed with the proximal end of the right internal mammary artery. The blood supply of the flap was good during surgery. The left breast mastopexy was completed at the same time, and the donor site of thigh and abdomen was closed directly. The flap survived well and the donor site healed well after surgery. During the follow-up of 7 months post surgery, the appearance and function of thigh donor site were good, no obvious complications were found, and the reconstructed breast was smaller than the contralateral side. This case suggests that the profunda artery perforator flap could be a valuable option as an alternative for DIEP harvesting failure for autologous breast reconstruction.