Background: Because of the widespread and high reliability of free flaps in head and neck reconstruction, the challenge today is to reduce donor site morbidity. The external pudendal artery (EPA) free flap has been described in men and provides a minimal functional and cosmetic impact. This study aimed to assess the feasibility of the EPA free flap in women for buccopharyngeal reconstruction.
Methods: A dissection of the inguinal region was performed bilaterally on fresh female cadavers. The anatomy of the EPA and its angiosome were described, along with the design of the EPA free flap. A computed tomography angiographic study of the flap perfusion was performed.
Results: Fourteen cadavers were dissected. The EPA was constant. Its diameter ranged from 1.12 to 2.96 mm (median 2.0 mm). The mean area of its angiosome was 167.3 ± 38.5 cm2. An axial fasciocutaneous flap was designed with a horizontal skin paddle measuring on average 9.2 × 6 cm and a pedicle length of 8.4 ± 1.9 cm. The mean flap thickness was 11.7 ± 6.8 mm and depended on individual factors. A primary closure was achieved in all cases with a scar hidden in the underwear.
Conclusions: This anatomical study demonstrates that the EPA seems constant despite variations in its origin pattern. Its diameter and angiosome allow the design of an EPA free flap in women. A clinical study should confirm that this flap is suitable for the repair of buccopharyngeal defects and could be added to the armamentarium of the head and neck reconstructive surgeon.
Keywords: Buccopharyngeal reconstruction; External pudendal artery; Free flap; Head and neck; Reconstructive surgery.
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