Lower Medial Thigh Perforator Flap: The New Innovation for Head and Neck Reconstruction

Background: The choice of optimal flap is still a challenge for patients with resection of recurrent head and neck cancer and reconstruction. This paper reported the new innovation of free lower medial thigh perforator (LMTP) flap for head and neck reconstruction.

Patients and Methods: Fifteen patients received reconstruction with free LMTP flaps. The defect locations included the buccal area (3 cases), tongue (6 cases), lower/upper gum (5 cases), and soft palate (1 case). The perforators of flap design were detected at the distal third of the line, which was drawn from medial upper border of patella to the midpoint of inguinal ligament. The superficial temporal artery (7 cases), superior thyroid artery (6 cases) and facial artery (2 cases) were dissected as recipient vessels.

Results: The flap sizes varied from 12×5 cm² to 20×8 cm². One to two perforators were found during dissection between the septum of satorius and vastus medialis, or intramuscular dissection of vastus medialis. Flaps were raised based on the distal perforators of the superficial femoral artery (SFA) or descending genicular artery (DGA). All of flaps were survived after surgery, except one failed due to venous thrombosis.Another one flap suffered from venous thrombosis and wassuccessfully salvaged by performing a venous thrombectomy. All donor sites were primarily closed except one skin grafting. Follow-up observations revealed all patients had good recovery with satisfactory cosmetic results.

Conclusion: The LMTP flap indicates a pliable with constant vascular anatomy and low donor-site morbidity. It could be an alternative option for reconstructing defects in head and neck region.