Perforator Flaps in Head and Neck Reconstruction

Youn Hwan Kim; Jeong Tae Kim

doi:10.7599/hmr.2009.29.3.265

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Kim and Kim: Perforator Flaps in Head and Neck Reconstruction

Review Article

Hanyang Medical Reviews 2009; 29(3): 265-273.

Published online: 31 August 2009

DOI: https://doi.org/10.7599/hmr.2009.29.3.265

Perforator Flaps in Head and Neck Reconstruction

Youn Hwan Kim, M.D., Jeong Tae Kim, M.D., Ph.D.

Department of Plastic and Reconstructive Surgery, School of Medicine, Hanyang University, Seoul, Korea.

Corresponding author (jtkim@hanyang.ac.kr)

Received 25 May 2009 Accepted 10 August 2009

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Basic requirements of head and neck reconstructions are thin resurfacing, a long vascular pedicle, 3-dimensional and well customized reconstruction with a team approach.

Ideal reconstruction methods were thought to be free tissue transfer including radial forearm flap, latissmus dorsi or rectus abdominis myocutaneous flap. But recently, there has been concerns about sacrifice of donor structures in these conventional flaps. For minimal sacrifice of donor structures, there has been much evolution in flap concepts, which lead to the introduction of perforator flaps. They are popular in every region for reconstruction. Anterolatral thigh, latissmus dorsi or deep inferior epigastric artery perforator flaps are commonly used.

Perforator flaps could also be applied to head and neck reconstructions, because they could be used for the controlled resurfacing of scalp, cheek, neck, oropharynx, and for customized 3-dimensional reconstructions, including diverse components according to each perforator, which may result in more comfortable handling and less restricted access to the defect. The perforator flaps also have long vascular pedicles compared to conventional myocutaneous flaps, which can lead to less restriction in choosing recipient vessels.

Perforator flaps have known to have many advantages as described and they give one more option in head and neck reconstruction.

Keywords: Perforator flaps, Head and neck reconstruction

Figures and Tables

Fig. 1

Cadaver dissection shows three groups of perforator in axilla area. First rows(yellow) indicate musculotaneous perforator group, mid rows(blue) indicate septocutaneous perforator group and the other anterior rows(pink) indicate direct cutaneous group.

Fig. 2

(Left) preoperative view of tongue cancer. (Right) postoperative view of tongue resurfacing using perforator flap.

Fig. 3

(Above, Left) Recurrent squamous cell carcinoma in scalp. (Above, Right) 28×16 cm thoracodorsal artery perforator flap was used for resurfacing. (Below, Left) Preoperative view of skin defect and MRSA infection after cranioplasty. (Below, Right) A thoracodorsal artery perforator flap was used for the resurfacing of scalp defects.

Fig. 4

(Above, Left) Recurrent MRSA infection of artificial dura and cerebritis (Above, Right) Intraoperative view of cranium (Below, Left) Vastus Lateralis perforator flap which is known as anterolateral thigh perforator flap was elevated. (Below, Right) postoperative view of scalp resurfacing.

Fig. 5

(Above, Left) Old male patient had suffered pharyngeal cancer with fistula formation and huge chyle leakage. (Above, Right) A septocutaneous perforator flap for pharyngeal lining and a musculocutaneous perforator skin flap for outer lining were elevated in anterolateral thigh. (Below, Left) Flap insetting for customized reconstruction. (Below, Right) Postoperative view shows successful reconstruction of pharyngeal lining and outer resurfacing.

Fig. 6

(Above, Left) total pharyngolaryngectomy state. (Above, Right) tubed latissimus dorsi perforator flap was elevated for cervical esophageal reconstruction. (Below, Left) Flap insetting for neoesophagus. (Below, Right) Postoperative endoscopic view shows successful reconstruction of esophagus.

Fig. 7

(Above and Below) Generally latissimus dorsi or thracodorsal artery perforator flap is located more anterior to conventional muscle flap therefore you can harvest these flaps on supine position for two team approach.

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