Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Patients with a history of head and neck cancer requiring complex free flap reconstruction represent challenging dilemmas for head and neck surgeons. The thoracoacromial system (TAS) provides an attractive in-field rotational option for reconstruction in an otherwise vessel-depleted neck. The flap can be harvested by first isolating the perforator through the pectoralis major muscle and then dissecting the perforator to the pectoral or deltoid branch of the TAS. With more proximal dissection, an additional 6-8 cm of pedicle length can be gained. Due to its proximity to the head and neck, the thoracoacromial artery perforator flap (TAPF) is versatile flap that can be used as a pedicled flap for head and neck defects.
Methods: A single institution retrospective review at a tertiary academic medical center who underwent a TAPF for head and neck reconstruction. The utility of the flap in reconstructing multifaceted defects is described.
Results: Three patients underwent a TAPF with success after previous treatment with head and neck cancers. Two out of three (67%) patients underwent de-epithelized buried flaps and 1 out of 3 (33%) necessitated a skin paddle for reconstruction. There were no partial flap failures or fistulas associated with the TAPF. Although, one patient had a planned controlled pharyngostome as part of the reconstruction. The amount of tissue and thickness of the flap was appropriate for each of the surgical defects and/or wounds. In this series, there were no complications associated the TAPF including harvest, inset or healing of the flap.
Conclusion: The TAPF has demonstrated to be a reliable axial flap to reconstruct several head and neck defects. This series describes the indications, the harvest technique, and the outcomes of those who underwent reconstruction with this flap.