Liposuction Contouring After Head and Neck Free Flap Reconstruction

Abstract

Resection of bulky head and neck tumors is typically followed by microvascular free flap reconstruction. The latter has shown an acceptable success rate but often requires a secondary revision with a free tissue transfer reconstruction to improve outcome; both cosmetic and functional. Direct surgical revision via electrocautery/scalpel poses a high risk of flap perfusion compromise. Suction assisted lipectomy on the other hand is a feasible and safe technique that offers favorable contouring with comparable restoration cosmetic and functional outcomes. In this article, we review the indications and advantages of this technique and provide an outlook on its safety and pitfalls.

Redefining Fasciocutaneous Microanatomy: An Illustrated Review of Current Concepts and Their Clinical Correlates

“…Partial debridement, retaining the deepest, flimsy layer of reticular dermis, maintains the bed's deep dermal plexus (Figure 1 label #11) [2]. To maintain the subdermal plexus in a raised flap/graft, surgeons preserve at least 1 mm of fat during scalpel/scissor dissection [2,83], and 3-5 mm during open-tip liposuction and/or arthroscopic shaving [84,85]. During de-fatting, maintaining the honeycomb fascia helps preserve septal vessels (Figure 1 label #13) [2].…”

Secondary contouring of flaps

“…Liposuction is safe to perform after a minimum of 3 months postoperatively and when the flap is viable without its main vascular pedicles [1,4]. However, liposuction around the pedicles must be performed with care, as reports have described flap necrosis due to damaged vascular pedicles as long as 3 months after the operation [5]. Tumescent fluid containing epinephrine is injected preoperatively to reduce bleeding.…”

“…3) [6,7]. Such an excision may be performed after waiting a couple of months postsurgery to see if the contour improves naturally from contraction of the skin, rather than performing the excision immediately after liposuction [5]. Liposuction can be safely performed when secondary debulking is planned with an adipofascial flap and skin graft, or with a local flap, such as a distally-based sural flap.…”