Deep inferior epigastric artery perforated rectus abdominis free flap for head and neck reconstruction

Abstract

The deep inferior epigastric artery perforated rectus abdominis (DIEAP-ra) free flap is a modification of the classic myocutaneous DIEA free flap in which only fasciocutaneous tissue is harvested based on the paraumbilical perforators of the medial row. The aim of this retrospective study is to describe our experience with this reconstructive technique in head and neck surgery. Between 2004 and 2009, 24 patients affected by oncologic maxillofacial, skull base, oral, and oropharyngeal defects were submitted to reconstruction with DIEAP-ra. After harvesting the DIEAP-ra, the longitudinally split muscular belly was sutured and the anterior rectus sheath closed with a nonabsorbable mattress suture without inlay mesh interposition. Surgical defects encompassed half of the hard palate in ten patients, orbit and part of the cranial vault in one, radical extended parotidectomy in four, subtotal glossectomy in seven, and total glossectomy in two cases. The only complete flap necrosis (4%) developed as a consequence of an orocutaneous fistula and required a second latissimus dorsi free flap. Another case (4%) developed a partial necrosis for oropharyngeal fistula after total glossectomy that healed after transposition of a pedicled myofascial pectoralis major. Two patients (8%) presented a minor salivary fistula that healed by medication alone. No major complication of the donor site was observed. DIEAP-ra is a valid alternative to the DIEA free flap when applied to complex maxillofacial or tongue major defects. Its greatest advantages are the reduced donor site morbidity and a more adjustable thickness of the skin paddle, particularly in females and obese patients.

Free perforator flap transfer for reconstruction of skull base defects after resection of advanced recurrent tumor

“…[9][10][11] The DIEAP flap provides adequate flap bulk and is suitable for large three-dimensional reconstructions of craniofacial defects involving orbits and maxillas. 12,13 The TAP flap may provide a large flap volume and a long pedicle, 14 and our experience showed that it is suitable for reconstructions of cranial bone defects with large areas of scalp defects. However, the patient may need to change position during the surgery.…”

“…A variable amount of the vastus lateralis muscle can be included with the fascia and skin components of the flap for deep defects requiring bulk to restore the craniofacial contour or defects in which dural or other critical neurovascular structures need coverage . The DIEAP flap provides adequate flap bulk and is suitable for large three‐dimensional reconstructions of craniofacial defects involving orbits and maxillas . The TAP flap may provide a large flap volume and a long pedicle, and our experience showed that it is suitable for reconstructions of cranial bone defects with large areas of scalp defects.…”

The effect of admission to intensive care unit on outcomes and complication rates after head and neck reconstruction

“…Although DSS an OS are low due to loco-regional recurrence or distant metastases in total or subtotal glossectomy and despite we did not performed a quality of life assessment, the patients reconstructed with a vertical rectus abdominis muscle flap referred an improvement in the quality of life following reconstruction. Functional rehabilitation remains difficult but the use of the myocutaneous free flap has been demonstrated to deliver good outcomes [18]. In our series, the vertical rectus abdominis muscle flap was fixed anteriorly to the mandible and posteriorly to the base of tongue.…”

The Role of Free Tissue Transfer in Merkel Cell Carcinoma of the Head and Neck

“…When large amounts of muscles are harvested, donor site morbidity is increased and therefore, it is our opinion that other free tissue donor sites offer several advantages over the rectus abdominis flap in the majority of cases. Muscle sparing perforator style flaps may allow for decreased morbidity and superior control of flap thickness, and the deep inferior epigastria artery-based flaps have been shown to be a valid reliable option for head and neck reconstruction [26]. …”