Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Basel, Switzerland.
J Plast Reconstr Aesthet Surg. 2024 Aug;95:35-42. doi: 10.1016/j.bjps.2024.05.028. Epub 2024 May 31.
Total or subtotal glossectomy defects cause significant functional deficits in swallowing and speech and subsequently impair patients' quality of life (QOL). Recently, the profunda artery perforator (PAP) flap has emerged as a potential alternative for reconstructing extensive glossectomy defects. While previous studies assessing recovery of neurotized anterolateral thigh (ALT) flaps in head and neck reconstruction reported superior sensory recovery, improved swallow function, and improved overall patient satisfaction in patients with neurotized flaps vs. non-neurotized ALT flap reconstruction, PAP flap neurotization has not been described and systematically assessed in head and neck patients.
Six patients underwent subtotal tongue reconstruction with neurotized PAP flaps at the authors' institution from May 2022 until August 2023. A branch of the posterior femoral cutaneous nerve of the PAP flap was coaptated to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament, pain, and temperature assessments were conducted at 3, 6, and 12 months postoperatively on the neo-tongue. The MD Anderson speech and deglutition scales and the EORTC-QLQ-H&N35 were used to record functional outcomes and QOL.
The mean age was 69 ± 4 years, and the mean body mass index was 25 ± 7 kg/m. Neo-tongue median 2-point discrimination at the tip improved from >10 mm at 3 months to 6 mm at 12 months. All patients had protective pain and temperature perception at the neo-tongue tip at the 6-month follow-up. Speech and swallowing functions were similar at the 12-month follow-up to data on neurotized ALT flaps from literature. No neuropathic pain was reported at the donor site at the 6-month follow-up.
This is the first case series of PAP flap neurotization in head and neck patients, suggesting potential functional advantages with minimal donor-site morbidity.
V Case Series.
全舌或部分舌切除术缺陷会导致吞咽和言语功能严重受损，进而降低患者的生活质量（QOL）。最近，深穿支动脉皮瓣（PAP 皮瓣）已成为广泛舌切除术缺陷重建的一种潜在替代方法。既往研究评估了神经化股前外侧（ALT）皮瓣对头颈部重建的恢复情况，报告称神经化皮瓣组患者的感觉恢复更好，吞咽功能改善，整体患者满意度更高，而非神经化 ALT 皮瓣组患者的感觉恢复更差，吞咽功能改善更差，但 PAP 皮瓣神经化在头颈部患者中尚未得到描述和系统评估。
作者所在机构自 2022 年 5 月至 2023 年 8 月期间对 6 例患者进行了 PAP 皮瓣神经化部分舌切除术。PAP 皮瓣的后股皮神经分支与舌神经吻合。术后 3、6 和 12 个月，对新舌进行两点辨别觉、Semmes-Weinstein 单丝、疼痛和温度评估。采用 MD Anderson 言语和吞咽量表以及 EORTC-QLQ-H&N35 评估功能结局和生活质量。
患者的平均年龄为 69±4 岁，平均 BMI 为 25±7kg/m。新舌尖端的中位两点辨别觉从 3 个月时的>10mm改善到 12 个月时的 6mm。所有患者在 6 个月随访时新舌尖端均有保护性疼痛和温度感知。在 12 个月随访时，与文献中神经化 ALT 皮瓣的数据相比，患者的言语和吞咽功能相似。在 6 个月随访时，供区无神经病理性疼痛报告。
这是首例 PAP 皮瓣神经化用于头颈部患者的病例系列研究，提示该方法具有潜在的功能优势，且供区并发症少。
V 病例系列。
