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Ma C, Gao W, Zhu D, Zhang J, Shen Y, Wang L, Wang J, Haugen TW, Sun J, Zhu Y. Profunda Artery Perforator Flaps From the Posteromedial Region of the Thigh for Head and Neck Reconstruction. Otolaryngol Head Neck Surg 2023; 168:345-356. [PMID: 35787195 DOI: 10.1177/01945998221109145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Profunda femoris artery perforator flaps (PAPFs) have not been widely used in head and neck reconstructions. The feasibility and outcomes of PAPFs for various head and neck reconstructions need to be investigated. STUDY DESIGN Retrospective analysis. SETTING A single-institution review. METHODS PAPFs were utilized in head and neck reconstructions from 2019 to 2021. Local anatomy, surgical technique, and complications were discussed. Chimeric PAPF applications with muscle components were described for coverage of extensive multiunit defects. Additionally, aesthetic and functional outcomes were compared with anterolateral thigh perforator flaps. RESULTS A total of 33 cases were included. The average age was 54.2 years (range, 30-74). The most common underlying pathology was oral squamous cell carcinoma (n = 26, 78.8%), while the mean ± SD body mass index was 25.4 ± 2.8 kg/m2 . Middle perforators (n = 14, 42.4%) were the most commonly utilized ones. The perforator-based chimeric/composite applications were used in 9 (27.3%), with the muscular components consisting of gracilis (n = 3, 9.1%), adductor magnus (n = 5, 15.2%), or semimembranosus muscles (n = 1, 3.0%). Venous thromboses of the PAPFs were found in 2 (6.1%), though salvaged. The occurrence of postoperative 90-day morbidity (complication) was related to mandibulectomy/maxillectomy (P = .020). Postoperative validated questionnaires showed a trend of intermediate to high scores, indicating noninferior outcomes in several categories, when compared with the anterolateral thigh perforator flap counterparts. CONCLUSION PAPFs are a good reconstructive alternative for intermediate to large head and neck reconstructions. Besides, PAPFs can provide sufficient tissue volume and versatility of potentially incorporating adjacent muscle components.
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Affiliation(s)
- Chunyue Ma
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Weijin Gao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dan Zhu
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianfei Zhang
- Department of Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yi Shen
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Liang Wang
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jinbing Wang
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Thorsen W Haugen
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Jian Sun
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yaxin Zhu
- Department of CT Clinical Research, CT Business Unit, Canon Medical Systems Co, Ltd, Beijing, China
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Perforators of the Anteromedial Thigh Skin and Possible Design of the Anteromedial Thigh Flap: A Cadaveric Study. Ann Plast Surg 2022; 89:312-325. [PMID: 35703208 DOI: 10.1097/sap.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Specific perforator-based flaps are a new era in plastic reconstruction. They have replaced many of the traditional paradigms in plastic surgery. The anteromedial thigh flap is a versatile flap that can be used as a primary choice for many reconstructive purposes or as a secondary choice for the anterolateral thigh flap. Mapping the vascular territory of anteromedial thigh is essential for the proper design of the flap. AIM OF THE WORK The aim of this work was to study the cutaneous perforators of the anteromedial thigh and explain their significance in flap design. MATERIAL AND METHODS The material of this study included 30 fresh cadaveric lower limbs. The external iliac artery was injected with colored latex. Superficial and deep dissections were undertaken under a magnifying lens to locate the perforators and identify their type. The length and diameter of the perforators were measured. RESULTS Anteromedial thigh skin was divided into 6 squares. Squares 1 and 4 are the upper squares and comprise the skin over the upper medial thigh. It is primarily based on the superficial external pudendal artery, deep external pudendal artery, and superficial circumflex femoral artery. Squares 2 and 5 are the middle squares and were mainly supplied by perforators of the superficial femoral artery. Squares 3 and 6 are the lower squares and were mainly supplied by the saphenous artery and superficial femoral artery. The possible flap designs are then discussed. CONCLUSION The anteromedial thigh skin is richly supplied by a mixture of perforators from multiple sources. The segmental nature of the perforators arising from the superficial external pudendal artery, deep external pudendal artery, superficial femoral artery, and saphenous artery together with the long course and large diameter of perforators grant the anteromedial thigh flap its versatility.
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