title: Advantages of perforator flaps in reconstruction of complex defects of the head and neck.
abstract: Microsurgical transfer of vascularized tissue during the past three decades has allowed highly complicated postoncologic defects in the head and neck region to be reconstructed. Recently, perforator flaps have been used to reduce postoperative pain, shorten hospital stay, and lessen donor-site complications. These flaps are offsprings of previously known musculocutaneous and fasciocutaneous flaps and are harvested with preservation of the underlying muscular and fascial structures. The vascularized skin and soft-tissue envelope is supplied by perforating branches from the parent vessel. Less is known about the performance of these flaps in the head and neck region. During a 4-year period, 22 patients at our institution underwent reconstruction of the head and neck region with deep inferior epigastric perforator (DIEP) or thoracodorsal artery perforator (TDAP) flaps. All but one of the flaps survived. Advantages noted include: (1) longer vascular pedicles, (2) less postoperative pain, (3) less donor-site deformity, (4) improved aesthetic outcome, (5)potential for a neurosensory flap, (6) potential for an osteocutaneous flap, and (7) ease of postoperative radiologic follow-up. The DIEP flap can be harvested concurrent with oncologic resection, with the patient in the supine position. The TDAP flap is dissected with the patient in the decubitus position, creating an additional step to change operative position, and separates extirpative and reconstructive stages.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, USA.
authors.forename: Aldo Benjamin
authors.initials: AB
authors.lastname: Guerra
authors.forename: George Dewey
authors.initials: GD
authors.lastname: Lyons
authors.forename: Charles Louis
authors.initials: CL
authors.lastname: Dupin
authors.forename: Stephen Eric
authors.initials: SE
authors.lastname: Metzinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D014945:Wound Healing / Q000502:physiology