Versatility of the thoracoacromial artery perforator flap in head and neck reconstruction.

Abstract

The thoracoacromial artery perforator (TAAP) flap used in its pedicle or in the free microvascular variant is an emerging flap for use as a reconstructive option for the head and neck region. Between 2006 and 2013, 17 patients with a mean age of 34 years (range, 17-59 years) underwent a TAAP flap procedure for reconstruction of postoncologic and posttraumatic head and neck defects. The pedicle TAAP flap was used to reconstruct neck (n = 5) and hypopharyngeal defects (n = 5); the free TAAP flap was used to resurface lower hemiface (n = 4), tongue (n = 1), and intraoral (n = 2) defects. The flap size ranged from 4.5 × 7 cm to 12 × 17 cm, with a mean thickness of 0.5 cm. The pectoralis major muscle was preserved in all of the cases. All of the patients healed uneventfully. The donor site was closed directly in four cases; a skin graft was used in four patients, and the donor site was covered by a local flap in one case. Our experience proved the consistent feasibility of the successful use of the TAAP flap for head and neck reconstructions resulting in adequate color matching, texture, and pliability in combination with limited anterior chest wall donor site morbidity. Its hairless nature ensures that this flap is a suitable primary option for inner lining reconstruction of oropharyngeal defects.