Reconstruction of Total Laryngopharyngectomy Defects with Deep Inferior Epigastric Perforator Flaps

ABSTRACT

Laryngopharyngectomy reconstruction with microvascular free flaps remains challenging. Current methods of reconstruction include anterolateral thigh, radial forearm, and jejunal flaps, all of which have substantial donor site morbidity. We present a novel approach for total laryngopharyngectomy reconstruction using deep inferior epigastric perforator (DIEP) flaps. A retrospective review of head and neck reconstruction cases performed at Harbor-UCLA from 2006 to 2007 was performed. Those undergoing DIEP flaps were identified; management and postoperative course were analyzed. Two patients underwent successful reconstruction of total laryngopharyngectomy defects using DIEP flaps. Flaps up to 10 × 30 cm were harvested. Average donor vessel diameters were 2.5 cm and 3.0 cm for the artery and vein, respectively. The abdominal wounds were closed primarily. Flap survival was 100% with no emergent reexplorations. There were no postoperative bulges or hernias, and no leaks were detected on postoperative swallow evaluation. The DIEP flap is a useful addition to the armamentarium for reconstruction of total laryngopharyngectomy defects. Pedicle length is abundant, and donor vessel caliber is excellent. Large surface-area flaps can be harvested; excess flap can be deepithelialized or utilized for external skin. Primary closure of the donor site can be routinely achieved, negating the need for skin grafts.

Deep inferior epigastric perforator - laryngopharyngectomy - microvascular reconstruction

REFERENCES

• 1 Clark J R, Gilbert R, Irish J, Brown D, Neligan P, Gullane P J. Morbidity after flap reconstruction of hypopharyngeal defects.  Laryngoscope. 2006;  116 173-181
• 2 Azizzadeh B, Yafai S, Rawnsley J D et al.. Radial forearm free flap pharyngoesophageal reconstruction.  Laryngoscope. 2001;  111 807-810
• 3 Yu P, Lewin J S, Reece G P, Robb G L. Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap.  Plast Reconstr Surg. 2006;  117 968-974
• 4 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle.  Br J Plast Surg. 1989;  42 645-648
• 5 Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N. Free thin paraumbilical perforator-based flaps.  Ann Plast Surg. 1992;  29 12-17
• 6 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
• 7 Guerra A B, Lyons G D, Dupin C L, Metzinger S E. Advantages of perforator flaps in reconstruction of complex defects of the head and neck.  Ear Nose Throat J. 2005;  84 441-447
• 8 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
• 9 Boyd J B, Taylor G I, Corlett R. The vascular territories of the superior epigastric and the deep inferior epigastric systems.  Plast Reconstr Surg. 1984;  73 1-16
• 10 Garvey P B, Buchel E W, Pockaj B A et al.. DIEP and pedicled TRAM flaps: a comparison of outcomes.  Plast Reconstr Surg. 2006;  117 1711-1719 discussion 1720-1721
• 11 Vyas R M, Dickinson B P, Fastekjian J H, Watson J P, Dalio A L, Crisera C A. Risk factors for abdominal donor-site morbidity in free flap breast reconstruction.  Plast Reconstr Surg. 2008;  121 1519-1526