**5.4 Extended or 'Fleur-de-PAP' modification**

The 'fleur-de-PAP' is a mosaic expanded modification of the standard PAP flap. Specifically, it includes both a transverse and vertical component to incorporate additional tissue [12, 13]. This increases volume at the cost of a longitudinal scar in the medial mid-axial thigh and a 'T'-junction closure. Markings are similar, and emphasis should be placed on location of the dominant perforator to establish a central point for which the transverse and vertical components converge. Width is also determined by a skin pinch. Flap elevation is identical to that of the standard profunda artery perforator flap harvest (**Figure 5**).
