Cave, Taylor

An extended orbital exenteration defect in a male in his mid-80s was successfully reconstructed with a medial sural artery perforator flap. To our knowledge, this flap has not been described in the literature for such defects until now. While it may require meticulous intramuscular perforator dissection, it provides several advantages; it is thin, pliable, has a long pedicle of large calibre facilitating microanastomosis and provides adequate coverage where the amount of chimeric muscle can easily be tailored to the defect’s surface area and volume. In addition, its robust vascular supply can withstand volume changes post radiation therapy. Two years after surgery, the patient has healed well with an excellent functional outcome.

AbstractObjectiveThe profunda artery perforator (PAP) flap has gained popularity in head and neck reconstruction with a favorable donor site providing a relatively hidden scar and the ability to harvest a large amount of pliable tissue with consistent vascular anatomy. The primary aim of this study is to evaluate the safety and efficacy of this PAP flap in head and neck reconstruction.Data SourcesPUBMED, EMBASE, Web of Science, Google Scholar (January 1948‐February 2022).Review MethodsA systematic review of the English language literature was conducted for studies with at least 3 patients 18 years or older undergoing head and neck reconstruction utilizing the PAP. Study quality and risk of bias were evaluated using the MINORS scoring system. Main analysis endpoints were flap failure rate, donor site morbidity, and complication rate.ResultsNine articles and 206 total PAP flaps were included. The rate of flap‐related and medical complications was 33%, with only 2 (0.97%) instances of complete flap failure. Other complications included partial flap failure (10, 4.86%) and donor site wound complications (12, 5.83%). A total of 16 flaps (7.77%) required subsequent revision in the operating room. Average MINORS score of the studies suggested a moderate to high risk of bias.ConclusionBased on limited quality evidence, this review suggests that the PAP flap is a safe and feasible tool for head and neck reconstruction, with comparable complication and success rates as other free flaps. Further large‐scale studies are warranted.