From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2021 Jun 1;147(6):1401-1412. doi: 10.1097/PRS.0000000000007977.
Although the profunda artery perforator flap has gained popularity in breast reconstruction, it has not been well described for reconstruction of head and neck defects. The authors report their experience with free profunda artery perforator flaps in postoncologic head and neck reconstruction.
A retrospective review of all free profunda artery perforator flaps used for head and neck reconstruction from 2016 to 2019 was performed.
Overall, 61 profunda artery perforator flap reconstructions were performed: 45 single independent flaps, 12 in conjunction with a second free flap, and four in combination with two other free flaps. The profunda artery perforator flaps were most commonly used for reconstruction of the tongue (n = 19), cheek (n = 11), parotid (n = 10), and maxilla (n = 6). The profunda artery perforator flaps averaged 7.1 × 12.1 × 1.9 cm, with a mean pedicle length of 11.5 cm. The A, B, and C perforators were located at mean distances of 7.4 cm (range, 4 to 11.5 cm), 11.7 cm (range, 8 to 18 cm), and 16.1 cm (range, 14 to 20.5 cm) from the pubic tubercle along the axis of the adductor longus muscle and 7.9 cm (range, 7 to 11cm), 7.6 cm (range, 7 to 15.5 cm), and 7.2 cm (range, 6 to 16 cm) posterior and perpendicular to the axis. There were three partial flap losses. Eight patients (13 percent) had recipient-site complications necessitating operative intervention: four for vascular compromise of the profunda artery perforator flap, two for hematoma evacuation, and two for infection. Donor-site complications were noted in seven patients (11 percent), two of whom required operative intervention.
The profunda artery perforator flap is a versatile and reliable flap with consistent anatomy and a low complication rate. The profunda artery perforator flap seems to be a reasonable alternative for reconstruction of head and neck defects.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
尽管深动脉穿支皮瓣在乳房重建中已得到广泛应用，但在头颈部缺损重建中尚未得到很好的描述。作者报告了他们在头颈部肿瘤后应用游离深动脉穿支皮瓣进行重建的经验。
对 2016 年至 2019 年期间用于头颈部重建的所有游离深动脉穿支皮瓣进行回顾性分析。
共进行了 61 例深动脉穿支皮瓣重建术：45 例为单一独立皮瓣，12 例与第二游离皮瓣联合，4 例与两个其他游离皮瓣联合。深动脉穿支皮瓣最常用于重建舌（n=19）、颊（n=11）、腮腺（n=10）和上颌（n=6）。深动脉穿支皮瓣平均大小为 7.1×12.1×1.9cm，蒂长平均为 11.5cm。A、B 和 C 穿支分别距耻骨结节沿内收长肌轴的平均距离为 7.4cm（范围为 4 至 11.5cm）、11.7cm（范围为 8 至 18cm）和 16.1cm（范围为 14 至 20.5cm），与轴垂直且距后 7.9cm（范围为 7 至 11cm）、7.6cm（范围为 7 至 15.5cm）和 7.2cm（范围为 6 至 16cm）。有 3 例部分皮瓣坏死。8 例患者（13%）发生吻合口并发症，需手术干预：4 例深动脉穿支皮瓣血管受压，2 例血肿清除，2 例感染。7 例患者（11%）发生供区并发症，其中 2 例需手术干预。
深动脉穿支皮瓣是一种具有可靠的解剖学和低并发症发生率的多功能皮瓣。深动脉穿支皮瓣似乎是头颈部缺损重建的合理选择。
临床问题/证据水平：治疗，IV。
