Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Spedali Civili of Brescia, Piazza Spedali Civili 1, 25123 Brescia, Italy.
Eur Arch Otorhinolaryngol. 2012 Apr;269(4):1219-24. doi: 10.1007/s00405-011-1749-x. Epub 2011 Aug 25.
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.
穿支皮瓣游离腹壁下深动脉（DIEAP-ra）是经典的肌皮穿支游离腹壁下动脉（DIEA）皮瓣的改良术式，仅基于正中旁脐穿支获取筋膜皮瓣。本回顾性研究旨在描述我们在头颈部手术中应用这种重建技术的经验。2004 年至 2009 年间，24 例头颈部恶性肿瘤患者，包括颌面部、颅底、口腔和口咽缺损患者，采用 DIEAP-ra 进行重建。游离 DIEAP-ra 后，将肌腹纵向劈开并缝合，前腹直肌鞘采用不可吸收褥式缝线关闭，无需置入网片。手术缺损包括 10 例患者的半硬腭、1 例患者的眶和部分颅顶、4 例患者的广泛腮腺切除术、7 例患者的次全舌切除术和 2 例患者的全舌切除术。唯一的完全皮瓣坏死（4%）是由于口皮瘘引起的，需要再次行背阔肌游离皮瓣。另 1 例（4%）患者在全舌切除术后出现部分皮瓣坏死，口咽瘘愈合后采用带蒂胸大肌肌筋膜瓣转位。2 例（8%）患者出现轻微涎瘘，仅通过药物治疗愈合。供区无重大并发症。当应用于复杂的颌面部或舌部大缺损时，DIEAP-ra 是 DIEA 游离皮瓣的有效替代方案。其最大优势是减少供区并发症和更可调节的皮瓣厚度，尤其是在女性和肥胖患者中。
