Floor plan - 2013 Annual Meeting - American Association for Hand ...

Buried DIEP Flaps For Complex Head and Neck Contour Defects
Institution where the work was prepared: Georgetown University Medical Center, Washington, DC, USA
Mark W. Clemens, MD; Steven Paul Davison, MD, DDS, FACS; Georgetown University Hospital
BACKGROUND:
As the art of microsurgery advances, the demands are changing. No longer is the emphasis on anastamosis, but rather the focus has
turned to the donor site and the final functional result without aesthetic compromise. A prime example of this is head and neck reconstruction.
The expectation is now for a result that no longer fills a hole, but restores shape, dimension, and patient confidence; John
Winston Siebert's longitudinal work with facial atrophy exemplifies this philosophy. The DIEP flap has been 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 is not previously described for buried contour defects.
METHODS:
We present a retrospective study of a consecutive series of six buried DIEP flaps, performed between 2005 and 2006 with a review of
their indications, results, and complications. Three patient defects had previous radiation. The DIEP flaps were used for both functional
scar repair, bulk fill, and for soft tissue fill of contour defects. Five flaps were used in the delay setting, as secondary reconstructions
and one flap was designed with a monitor paddle of skin. Despite buried nature of flaps, postoperative monitoring was possible in all
cases by directed Doppler evaluation of anastamotic vessels.
RESULTS:
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 one
hundred percent 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 six months and one year was good to excellent in all cases.
CONCLUSIONS:
In select cases, we report the functional and aesthetic advantages of the DIEP flap for head and neck reconstruction of soft tissue defects
as superior to implants, fillers, and non-vascularized fat grafts. Donor site defects are minimized with no muscle loss. The subcutaneous fat
of the DIEP flap has resilience which tends to last and retain its shape. We observe maintenance of residual volume over muscle flaps.
During revisions, these flaps are amendable to liposuction as a contouring tool with portions that can be redistributed on pedicles.
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