The Posteromedial Thigh Flap for Head and Neck Reconstruction

Scaglioni, Mario F.; Kuo, Yur‐Ren; Yang, Johnson Chia‐Shen; Chen, Yen-Chou

doi:10.1097/prs.0000000000001414

Cited by 48 publications

(15 citation statements)

References 14 publications

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“…Mojallalal et al [10] have described the constancy of the location of the d-SFAP flap perforator at a mean distance of 22.79 ± 1.55 cm from the pubic tubercle and in close relation with the saphenous vein, which is comparable to the mean distance of 20.5 ± 3.17 cm in our study. Our data are also consistent with other studies that have found most of the perforators of the PAP flap located 8-10 cm from the pubic crease [3].…”

Section: Discussionsupporting

confidence: 93%

“…The PAP flap has become an ideal choice for autologous tissue breast reconstruction as an alternative to the deep inferior epigastric perforator flap [15]. However, there are few reports regarding its use for intraoral reconstruction [3,4,5]. The main concern in our population could be its greater thickness compared to the ALT flap, but with our results, we can show that there is not much difference when the PAP flap is designed around a distal perforator.…”

Section: Discussionmentioning

confidence: 62%

See 1 more Smart Citation

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Heredero¹,

Falguera²,

Sanjuan³

et al. 2019

IMJ

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Soft tissue microsurgical reconstruction in the head and neck regions can be performed with different types of free flaps. For decades, the anterolateral and anteromedial thigh regions have been considered as the ideal donor sites [1,2], especially in Asian countries. Recently, the profunda artery perforator (PAP) flap harvested from the posteromedial region of the thigh has been proposed as a good choice for use in oral cavity reconstruction [3,4,5]. However, in the Western countries, thigh flaps, especially the PAP flaps, are not used as often as in the Asian countries for oral reconstruction because there are concerns regarding the greater thickness of thigh flaps as compared with the radial forearm free flaps (RFFF). There are previous publications on anterolateral thigh (ALT) flap thickness measured with Doppler ultrasound [6,7] and only one study using computed tomographic angiography (CTA) [8]. However, none of these studies compare ALT flap thickness with PAP flap thickness in the same patient. The aim of this study was to compare the PAP flap thickness with the thickness of other thigh flaps that were more commonly used for intraoral reconstruction and to identify the factors influencing its thickness in our population using CTA. This information would be useful to facilitate flap selection based on desired tissue volume in patients with greater thigh thickness, like our population. MATERIAL AND METHODS Study Sample The study sample comprised 72 legs of 36 patients. The inclusion criteria were the patients who underwent head and neck microsurgical reconstruction with a fibula free flap and a preoperative CTA. The exclusion criteria consisted of the antecedent of previous thigh flap harvested. CTA was performed on a 64-slice multiple detector computed tomography scanner (LightSpeed VCT; GE Healthcare, Milwaukee, WI, USA) using a standardized protocol. Data post-processing was done using the open-source software Horos TM v 1.1.7 (GNU Lesser General Public License, version 3). Morphologic analysis of flap thickness and perforator location was done for the ALT flap, the anteromedial (AMT) flap, the distal superficial femoral artery perforator (d-SFAP) flap, and the PAP flap in all 72 legs. The d-SFAP flap is not commonly used for intraoral reconstruction, but it was also included in this study because of the constancy of the location of its perforator. For the ALT flap, the references were the anterior superior iliac spine (ASIS) and the superolateral border of the patella. The best perforator around the midpoint between both references was identified and its location relative to the ASIS was registered. The same references were used for the AMT flap. The cutaneous perforator of the AMT flap was located close to the intersection between the rectus femoris and sartorius muscles. The perforator's location (relative to the ASIS) and its origin-whether arising from the lateral circumflex femoral artery (LCFA), medial circumflex femoral artery (MCFA), or superficial femoral artery (SFA)-were identified. For the P...

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 62%

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Heredero¹,

Falguera²,

Sanjuan³

et al. 2019

IMJ

View full text Add to dashboard Cite

show abstract

“…Nevertheless, the ALT free flap is the most commonly used among all thigh flaps for tongue reconstruction. Three previous case series on the use of PAP flaps for head and neck reconstruction have been from Taiwan (Fernández‐Riera et al, ; Scaglioni et al, ; Wu et al, ), and one case series of eight patients from the United States (Mayo, Canizares, Torabi, Allen, & St Hilaire, ). In this case series, Mayo et al describe the versatility of this flap for various reconstructions, but only two were in the extraoral head and neck region and they did not report any PAP flap for intraoral reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the profunda artery perforator (PAP) flap, harvested from the posteromedial region of the thigh, has been proposed as a good choice for use in tongue reconstruction (Fernández-Riera, Hung, Wu, & Tsao, 2017;Scaglioni, Kuo, Yang, & Chen, 2015;Wu et al, 2016). In Western countries, thigh flaps, especially the PAP flap, are less frequently used than in Asian countries for tongue reconstruction.…”

Section: Introductionmentioning

confidence: 99%

The thin profunda femoral artery perforator flap for tongue reconstruction

et al. 2019

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Background With the ongoing global epidemic of obesity in the Western countries, thigh flaps such as the profunda artery perforator (PAP) free flap, have been less favorable for glossectomy reconstruction due to large bulk of adipose tissue associated with traditional subfascial harvest. In this article, we present a series of 10 patients who underwent reconstruction with suprafascial PAP free flaps following oncologic tongue resection. Methods Our series included six men and four women with an average age of 53.9 years old (range, 28–71 years). All patients underwent preoperative computed tomographic angiography (CTA) for selection of the most suitable perforator and preoperative design of its customized thickness. Flap elevation was performed at the superficial fascia layer while modifying the plane of dissection according to the specific bulk needs in each case. Results Flaps survived in nine patients; one flap failed due to vasospasm. Mean pedicle length was 7.4 cm (range, 6–8 cm). Skin paddle dimensions varied between 8 × 6 and 15 × 9 cm. Flaps thicknesses ranged from 0.4 to 3 cm. Functional outcome was evaluated at 6 months follow up: good speech and deglutition functional outcomes relative to extent of resection were observed. Conclusions The dissection above the superficial fascia layer represents an important refinement to the traditional fasciocutaneous PAP flap. Flap thickness can be tailored to avoid excess of bulk in the medial thigh observed in larger BMI populations.

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“…Bulky flaps assuring palatal‐glossal contact, such as the rectus abdominus (RA) and the anterolateral (ALT) free flaps, are among the most popular reconstructive options worldwide (Chepeha, 2010; Han et al, 2019). Recently, the profunda artery perforator (PAP) flap, harvested from the posteromedial region of the thigh, has been proposed as a good choice for tongue reconstruction (Fernández‐Riera et al, 2017; Heredero et al, 2019; Scaglioni et al, 2015; Wu et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Chimeric profunda artery perforator ‐ gracilis flap: A computed tomographic angiography study and case report

et al. 2020

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Background The possibility of harvesting the profunda artery perforator (PAP) flap in a chimeric configuration together with the innervated gracilis muscle may be a good option for dynamic reconstruction following total glossectomies. In this paper, we present a retrospective radiological study, which evaluates the presence and characteristics of the anatomical variation of the chimeric PAP – gracilis flap. Methods The study sample comprised 66 patients (132 legs), 38 men, and 28 women with an average age of 56 ± 2 years old, who underwent head and neck reconstruction with a free flap. Preoperative computed tomographic angiography (CTA) was used for morphologic analysis. We present a case report of a patient with a total glossectomy reconstructed with this flap. Results A perforator in the PAP area joining with the main pedicle of the gracilis muscle was found in 38 legs (28.8%). Mean length of the pedicle from the profunda femoral artery to the point where the perforator in the PAP area and the pedicle of the gracilis joined was 3.0 ± 0.3 cm. Differences in the existence of this vascular configuration were not significant comparing groups by sex, BMI, height, side or source vessel. Motion of the new tongue was documented clinically and with electromyography. The patient achieved an intelligible speech and normal diet. Conclusions Preoperative evaluation is necessary to assess the existence of a perforator in the PAP area joining with the main pedicle of the gracilis muscle. This chimeric flap has been demonstrated useful for dynamic reconstruction of a patient with a total glossectomy.

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The Posteromedial Thigh Flap for Head and Neck Reconstruction

Abstract: Therapeutic, IV.

Cited by 48 publications

References 14 publications

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

Comprehensive Analysis of Profunda Artery Perforator Flap Thickness Based on CTA

The thin profunda femoral artery perforator flap for tongue reconstruction

Chimeric profunda artery perforator ‐ gracilis flap: A computed tomographic angiography study and case report

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