DFAP (deep femoral artery perforator) Flap

The buttock is an area of abundant fat deposition in most women. A breast can be created using the skin, fat, and small blood vessel branches that nourish this tissue from both the upper (SGAP flap) and lower (IGAP flap) buttock. In contrast to the gluteus musculocutaneous flap, the gluteus muscles and muscle function are maintained with a gluteal perforator flap breast reconstruction procedure.

A lower buttock flap can remove the extra lower outer tissue of the buttock "saddle bag" without disturbing the upper central fullness of the buttock. The upper central fullness of the buttock is considered the "aesthetic unit" of the buttock and an attempt should be made to preserve it if possible. The scar resulting from a lower buttock flap is designed to fall in the inferior gluteal crease or shadow from the buttock, but a portion of the scar is usually not hidden by a regular bathing suit.

The lower buttock tissue is usually nourished by branches from the inferior gluteal artery. However, sometimes this tissue is nourished by branches from the deep femoral artery instead. The deep femoral artery has a completely different anatomic course through the tissue compared to the inferior gluteal artery. Advance knowledge of which blood vessel is nourishing the lower buttock tissue is thus crucial.

MRA imaging of the lower buttock tissue can be used to identify which blood vessel nourishes this tissue so that a IGAP flap or DFAP flap can be correctly planned and positioned. In addition, MRA identifies the exact location and characteristics of the blood vessels to enable the surgeon to choose the best blood vessel branch. The advance knowledge of the blood vessel characteristics from the MRA can enable a DFAP flap or IGAP flap to be shifted away from the center of the buttock, to impact less on the fat along the lower inner buttock that cushions when you sit.

Content Copyright, Dr. Julie Vasile