Buried Deep Inferior Epigastric Perforator Flaps for Complex Head and Neck Contour Defects

ABSTRACT

The deep inferior epigastric perforator (DIEP) flap is presented as a potential source of tissue for head and neck reconstruction. It has been sparingly reported for pharyngeal reconstruction and to provide a large bulk of skin but not previously described for buried contour defects. We present a retrospective study of a consecutive series of six buried DIEP flaps performed between 2005 and 2007 with a review of their indications, results, and complications. Three patient defects had previous radiation. All flaps were used in the delay setting as secondary reconstructions. Soft tissue defects addressed in this study were the result of a variety of different pathologies, including temporal fossa meningioma, fibrous dysplasia of the skull and orbit, nasopharyngeal carcinoma, neck scar repair, sinus cancer, and osteomyelitis. We report a 100% success rate with primary flap survival, secondary contouring, minimal donor site, provision of moldable bulk soft tissue fill, and ability to fillet and redistribute. Patient-reported satisfaction at 6 months and 1 year was good to excellent in all cases. We concluded that in select cases, the functional and aesthetic advantages of the DIEP flap for head and neck reconstruction of soft tissue defects are superior to implants, fillers, and nonvascularized fat grafts. During revisions, these flaps are amendable to liposuction as a contouring tool with portions that can be redistributed on pedicles. The subcutaneous fat of the DIEP flap has resilience that tends to last and retain its shape with maintenance of residual volume over muscle flaps.

KEYWORDS

DIEP flap - contour defects - head and neck reconstruction

REFERENCES

• 1 Siebert J W, Longaker M T. Aesthetic facial contour reconstruction with microvascular free flaps.  Clin Plast Surg. 2001;  28 361-366
• 2 Chiu E S, Sharma S, Siebert J W. Salvage of silicone-treated facial deformities using autogenous free tissue transfer.  Plast Reconstr Surg. 2005;  116 1195-1203
• 3 Owen C, Watkinson J C, Pracy P, Glaholm J. The psychosocial impact of head and neck cancer.  Clin Otolaryngol Allied Sci. 2001;  26 351-356
• 4 Callahan C. Facial disfigurement and sense of self in head and neck cancer.  Soc Work Health Care. 2004;  40 73-87
• 5 Song R, Gao Y, Song Y et al.. The forearm flap.  Clin Plast Surg. 1982;  9 21-26
• 6 Masia J, Leon X, Sancho J. Head and neck soft tissue reconstruction with perforator flaps.  J Craniomaxillofac Surg. 2006;  34S1 43-44
• 7 Urken M L, Weinberg H, Buchbinder D et al.. Microvascular free flaps in head and neck reconstruction: report of 200 cases and review of complications.  Arch Otolaryngol Head Neck Surg. 1994;  120 633-640
• 8 Timmons M J, Missotten F E, Poole M D et al.. Complications of radial forearm flap donor sites.  Br J Plast Surg. 1986;  39 176-178
• 9 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
• 10 Granzow J W, Levine J L, Chiu E S, Allen R J. Breast reconstruction with deep inferior epigastric perforator flap, history and an update on current technique.  J Plast Reconstr Aesthet Surg. 2006;  59 571-579
• 11 Guerra A B, Lyons G D, Dupin C L et al.. Advantages of perforator flaps in reconstruction of complex defects of the head and neck.  Ear Nose Throat J. 2005;  84 441-447
• 12 Beausang E S, McKay D, Brown D H et al.. Deep inferior epigastric artery perforator flaps in head and neck reconstruction.  Ann Plast Surg. 2003;  51 561-563
• 13 Woodworth B A, Gillespie M B, Day T, Kline R M. Muscle-sparing abdominal free flaps in head and neck reconstruction.  Head Neck. 2006;  28 802-807
• 14 Sandel H D, Davison S P. Microsurgical reconstruction for radiation necrosis: an evolving disease.  J Reconstr Microsurg. 2007;  23(4) 225-230
• 15 Hartrampf C R, Scheflan M, Black P W. Breast reconstruction with a transverse abdominal island flap.  Plast Reconstr Surg. 1982;  69(2) 216-225
• 16 Davison S P, Sherris D A, Meland N B. An algorithm for maxillectomy defect reconstruction.  Laryngoscope. 1998;  108 215-219
• 17 Sandel H D, Davison S P. Microsurgical reconstruction for radiation necrosis: an evolving disease.  J Reconstr Microsurg. 2007;  23 225-230