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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
HEAD AND NECK ONCOLOGY
Otorinolaringologia 2014 March;64(1):13-21
Perforator flaps in head and neck reconstruction: a review article of “the current state of the art”
Choi J. W.
Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Seoul Asan Medical Center, Seoul, Korea
In 1987, Ian Taylor introduced the angiosome concept, wherein the human body is divided into three-dimensional blocks of tissue that are fed by perforating arteries. This seminal advance in our knowledge of vascular anatomy inevitably led to innovations in local and free flap design and their use for clinical reconstruction. The field has seen random pattern flaps evolve in a linear fashion into fasciocutaneous flaps, which, in turn, evolved into myocutaneous flaps and, finally, perforator flaps. In head and neck reconstruction, the contemporary goals include anatomical and functional restoration as well as simple soft tissue coverage. To achieve these goals, sophisticated flaps and novel reconstructional techniques are needed. While the numerous axial pattern, fasciocutaneous, and musculocutaneous flaps that have been developed have played important roles in head and neck reconstruction, the advent of perforator flaps in recent years is opening a new era in head and neck reconstruction. The present review will discuss various aspects of perforator flaps when used for head and neck reconstruction, namely, the definition, history, nomenclature, and advantages and disadvantages of perforator flaps. The issues that are currently being debated in the field will also be discussed, including how the new perforasome concept theory expands the angiosome concept, the usefulness of Doppler and multi-detector-row computed tomography in perforator flap surgery, how to determine whether a perforator is large enough, the best method of dissection, and whether to use primary or secondary thinning with bulky flaps. Finally, the new “free-style perforator flap” will be discussed.