Anteromedial thigh septocutaneous perforator flap as a first choice for head and neck reconstruction: A clinical algorithm based on perforator-pedicle relationship

Chunyue Ma; Weijin Gao; Ahmed Abdelrehem; Dan Zhu; Yaxin Zhu; Jian Sun; Yi Shen

doi:10.1016/j.oraloncology.2022.105738

Anteromedial thigh septocutaneous perforator flap as a first choice for head and neck reconstruction: A clinical algorithm based on perforator-pedicle relationship

Oral Oncol. 2022 Mar:126:105738. doi: 10.1016/j.oraloncology.2022.105738. Epub 2022 Feb 2.

Authors

Chunyue Ma¹, Weijin Gao², Ahmed Abdelrehem³, Dan Zhu⁴, Yaxin Zhu⁵, Jian Sun⁶, Yi Shen⁷

Affiliations

¹ Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
² Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
³ Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
⁴ Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, Chinas.
⁵ Department of CT Clinical Research, CT Business Unit, Canon Medical Systems (China) CO. LTD., Beijing, China.
⁶ Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China. Electronic address: jianjian60@yahoo.com.
⁷ Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China. Electronic address: shenyi_777@126.com.

PMID: 35114613
DOI: 10.1016/j.oraloncology.2022.105738

Abstract

Background: Anterolateral thigh perforator flaps (ALTPFs) have long been considered workhorse flaps for head and neck reconstructions. However, in some instances, anteromedial thigh septocutaneous perforator flaps (AMTPFs) are easier to harvest than ALTPFs. This study aimed to determine when and how the AMTPF should be considered the first choice as a reconstructive tool.

Methods: A retrospective cohort study was performed in the Department of Oral and Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People Hospital, from January 2014 to December 2018. Both the perforator-pedicle relationships and postoperative functional outcomes were compared.

Results: A total of 168 patients were included in this study, among whom 49 underwent AMTPF reconstructions. The AMTPF perforators in this study were mostly septocutaneous (n = 38, 77.5%). Notably, the AMTPF perforators mainly originated from the medial branch of the descending branches of the lateral circumflex femoral arteries (n = 44, 89.8%), while for the other 5 patients, the perforators were found to originate from the superficial femoral arteries. Additionally, the average pedicle length of the AMTPFs was 8.7 cm (range: 6.0 to 13.0 cm), which was comparable to that of the ALTPFs (8.9 cm) (p = 0.442). The postoperative complication rate and functional outcomes were comparable between the two groups. The algorithm and harvesting approaches are presented.

Conclusions: The role of AMTPF should not be downplayed. After careful preoperative evaluation, we believe that AMTPF should not be considered a second choice in patients with sizable septocutaneous perforators.

Keywords: Algorithm; Anterolateral thigh perforator flap; Anteromedial thigh perforator flap; Pedicle; Septocutaneous/semi-septocutaneous perforator.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Algorithms
China
Humans
Perforator Flap* / surgery
Plastic Surgery Procedures*
Retrospective Studies
Thigh / surgery