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
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Mark W ClemensM.D.
Department of Plastic Surgery, Georgetown University Medical Center
3800 Reservoir Road NW, Washington, DC 20007
eMail: clemensmd@gmail.com