Anatomy Study Of Perforator Flap And Its Clinical Significance In Reconstruction Of Head And Neck Defects

Objective To study anatomy of perforator flap and explore its clinical application in reconstruction of head and neck defects.Material and methods Five fresh cadavers were prepared,and morphosis and blood supply of ALT flap,DIEAP flap,TDAP flap,IMAP flap,MSAP flap,TFLP flap were examined by microsurgery anatomy. During dissections,the following parameters were recorded:number and type of perforators vessels,diameter of perforators,pedicle length,diameter of the original vessels,route(infra fascia and supra fascia),and its position were located by anatomical landmark.Meanwhile,clinical cases in our hospital and published literatures about perforator flaps in reconstruction of head and neck defects were invested and analyzed.Results①There were an average 4.4 ALT perforators in each specimen with 68.2%musculocutaneous perforator and 31.8%septocutaneous perforator. The mean pedicle length of the largest perforator was 10.86±1.18cm,and its location is constantly concentrated in the superolateral region of the midpoint of the line linking the anterosupcrior iliac spine and superolateral border of the patella.The distance between surface location of the largest perforator and the midpoint was 3.25±0.69cm.Original vessel was mostly descend branch of lateral circumflex femoral artery/vein with average diameter of 3.16±0.59/3.08±0.02 mm.Flap success rate in reconstruction of head and neck defects was 93.7～100%.②There were an average 12.4 DIEAP musculocutaneous perforators in each specimen.The mean pedicle length of the largest perforator was 14.5±3.31cm.Average diameter of deep inferior epigastric artery/vein was 2.77±0.31,2.58±0.4mm.The location of the largest perforator ranged from 0～3cm in vertical axis,0～6cm in horizon axis to the umbilicus.Flap success rate was 91.67～96.88%.③There were 44 TDAP falp perforators in all specimen with 54.5%from lateral branch and 36.8%from medial branch of thoracodorsal artery.The lateral branch perforator mostly located within 2cm to the anterior border of latissimus dorsi muscle.The mean pedicle length of the largest perforator was 12.41±2.84cm.Average diameter of infrascapular artery/vein was 3.59±0.62,3.75±0.41 mm,average diameter of thoracodorsal artery/vein was2.71±0.43,2.98±0.18mm.Flap success rate was 80～100%.④There were 41 TFLP falp perforators in all specimen with 35 musculocutaneous perforator and 6 septocutaneous perforator.Original vessel was ascend branch of lateral circumflex femoral artery/vein with average diameter of 3,01±0.49mm/3.28±0.57mm.The mean pedicle length was 9.1±0.79cm.The surface location was 4.22±1.37cm laterally and 8.73±2.72cm beneath to anterosuperior iliac spine.Flap success rate 100%.⑤There were 29 MASP falp perforators in all specimen.Average diameter of original artery/vein was 2.6±0.63mm/2.84±0.64mm.The mean pedicle length was 13.5±3.11cm.The surface location was 5.3cm within to midline of posterior calf and 4.22～17.32cm beneath to popliteal crease.Flap success rate 91.7%.⑥All 1～4 IMMA perforators were found in 10 specimen.Average diameter of 1～4 IMMA perforator artery/vein was as follow:1.29±0.28,1.46±0.22mm, 1.1±0.27,1.41±0.39mm,0.87±0.23,1.17±0.15mm,0.92±0.22,1.12±0.14mm.The largest-perforator was mostly 1 or 2 IMAP.The angiosomal territory of IMAP extended from the clavicle superiorly to the xiphisternum inferiorly,from the midline medially to anterior axillary fold. Flap success rate was 100%.Conclusion:Studying anatomy of perforator flap is useful for operation and option in reconstruction of head neck defects.ALT flap,DIEAP flap and TDAP flap are mainhorses in reconstruction after head neck cancer ablation. MASP flap and TFLP flap will be available supplement flap.IMAP flap offers an excellent option in reconstruction of tracheostoma,anterior neck and cervical esophagus/trachea.