The versatile use of revisited de-epithelialization concept in superficial circumflex iliac and anterolateral thigh perforator free flap for head and neck reconstructions

Summary Background Although the perforator free flap is now a standard choice for head and neck reconstruction, problems such as microvascular complications, insufficient volume support for the defect, and fistula formation occur. We revisited a de-epithelialized concept for superficial circumflex i...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2017-06, Vol.45 (6), p.872-880
Main Authors: Choi, Jong Woo, MD, PhD, MMM, Kim, Young Chul, MD, Jeong, Woo Shik, MD, Koh, Kyung S, Oh, Tae Suk, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Dentistry
Female
Free flap
Head and neck cancer
Head and Neck Neoplasms - surgery
Humans
Iliac Artery - transplantation
Male
Microsurgery
Middle Aged
Perforator Flap - blood supply
Postoperative Complications
Reconstruction
Reconstructive Surgical Procedures - methods
Retrospective Studies
Surgery
Thigh - blood supply
Treatment Outcome
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Summary:Summary Background Although the perforator free flap is now a standard choice for head and neck reconstruction, problems such as microvascular complications, insufficient volume support for the defect, and fistula formation occur. We revisited a de-epithelialized concept for superficial circumflex iliac artery and anterolateral thigh perforator free flap to overcome these problems. Methods We applied the de-epithelized perforator free flaps in 35 cases among 761 microsurgical head and neck reconstructions and investigated flap characteristics (length gain of pedicle, flap size, and volumetric analysis) and outcomes (flap failure, partial flap necrosis, hematoma, infection, and fistula). Results Satisfactory results were achieved regarding flap survival, volumetric compensation, and fistula formation. Flaps were transferred successfully in all patients, although 1 patient underwent revisional operation due to venous congestion. Transferred flap volume was significantly higher than the resected tumor volume (p < 0.01), which suggests volume augmentation in the destroyed neck envelope and a protective role against adjuvant radiation. Minor dehiscence and bleeding were seen in two cases, and no other complications were identified. Conclusion The de-epithelialization concept for perforator free flap is helpful to overcome obstacles related to traditional free flaps in terms of flap survival and volumetric augmentation in head and neck reconstructions.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2017.02.010