PURPOSE:
“Aesthetic” soft tissue reconstruction using perforator flaps is now commonplace in breast reconstruction. In contrast, most head and neck free flap reconstructions are performed primarily for wound closure or functional rehabilitation. Our goal was to restore the soft tissue contour of the head and neck after tumor resection while minimizing donor site morbidity using adipofascial perforator flaps.
METHODS:
Soft tissue contour deformities in patients undergoing head and neck tumor resections were reconstructed with adipofascial free flaps. In some patients, the flap was totally buried. In other patients, a small cutaneous paddle (<10% of the flap area) was included to minimize wound tension or for flap monitoring. Free flap harvest was performed simultaneously with the resection using a two-team approach.
RESULTS:
Forty patients (25 males and 15 females) with a mean age of 53 years underwent immediate soft tissue reconstruction with an adipofascial perforator flap following head and neck oncologic resection with the primary goal of restoring aesthetic form between 2005 and 2009. Flaps included 37 anterolateral thigh and 3 deep inferior epigastric perforator flaps. Regions reconstructed could be grouped into one of three primary areas: parotid and/or temporal bone (n=24), malar cheek (n=13), and temporal fossa (n=3). Facial nerve reconstruction (e.g., nerve grafting, upper eyelid gold weight placement, lateral canthoplasty, lateral tarsorraphy, and/or fascial sling) was also performed in 18 patients. The mean total operative time was 10.4±2.4 hours. The time needed for reconstruction in excess of the oncologic resection was 3.1±1.5 hours. The mean length of hospital stay was 6.5±1.3 days. Recipient site complications included: 3 infections, 1 wound dehiscence, and 1 cerebrospinal fluid leak. Donor site complications included 5 seromas and 3 infections. There were no flap losses. Postoperative radiation therapy was administered in 23 patients and postoperative chemotherapy in 9 patients. In no case did a complication result in a delay in administering adjuvant therapy. Twenty (50%) patients underwent revision surgery for flap debulking and/or skin paddle removal. At a mean of 21.5±15.9 months of follow-up, 78% of patients are without evidence of disease. Of patients with a recurrence, 4 were detected radiologically and 5 were detected by physical exam. Soft tissue volume remains satisfactory in all patients, including those who underwent radiation therapy.
CONCLUSION:
Reconstruction of facial soft tissue contour with adipofascial perforator flaps is warranted in head and neck oncologic patients to restore body image and maintain quality of life. There is no evidence that such reconstructions or their common complications delay adjuvant treatment or interfere with the diagnosis of a recurrence.