Deep inferior epigastric artery perforator diep flap the diep flap is the technique where skin and tissue no muscle is taken from the abdomen in order to recreate the breast. True submental artery perforator flap for total softtissue chin reconstruction article in microsurgery 326. In 1993, martin et al first described the submental island flap sif as a reliable alternative to more conventional means of reconstruction after oncologic ablative procedures of the head and neck. Submental artery island flap in intraoral reconstruction. The principal perforator flaps such as facial artery perforator flap, platysma flap and its variant the submental flap and supraclavicular artery flap used in the head and neck reconstruction are. Workhorse flaps 56 perforator flaps in the lateral thoracic region, 648 jeongtae kim expert commentary stephanie a. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. Perforator flaps for breast reconstruction download. This is the most common procedure performed at our breast center as women generally have excess skin and fat along the lower portion of their abdomen. Vy advancement for chin reconstruction thornton, james fallon m. Submental flap for soft tissue reconstruction following. The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. It has a long up to 8 cm consistent, reliable pedicle, and cutaneous dimensions having reach up to 7 cm.
The purists among us stated that a muscle perforator flap is the only real perforator flap. Submental island flap local and regional flaps in head. Morris has had a longstanding interest in vascular anatomy and flap physiology and maintains a lab investigating a variety of tissue transfers. Free flap perforator flap musculocutaneous flap radial forearm flap skin. Perforator flaps has two volumes, a total of 1096 pages, and 972 references. Since its inception, the procedure has been successfully used in the reconstruction of the lower and mid face, 26 pharynx, 7 palate, 8, 9 oral cavity, 10, 11 and eye socket, 12 as well as the nose and columella. The submental artery island flap is a versatile option in head and neck reconstruction, which can be used as a pedicled or free flap. Submental artery islandsubmental artery island flapflap department of oral and maxillofacial surgery vinnitsa national medical university presentation by, patrick royson albertina sheehama supervised by. Submental artery perforator flap jeong tae kim upper extremity 15.
Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring. Brown expert commentary roberto puxeddu 43 groin flap and superficial circumflex iliac artery perforator flap, 478 isao koshima, kensuke tashiro, samir mardini, fuchan wei expert commentary joon pio jp hong 44 gluteus flap, e157 moustapha hamdi. Course material will include a program book with dissection guides and. The reader will find that these extraordinary statements are well supported by the case examples in the book. Deep inferior epigastric artery perforator diep flap. This comprehensive video library includes 29 perforator and axial pattern skin flap dissections in the head and neck, trunk, and upper and lower extremity. Pdf submental flap in reconstruction of orofacial defects. The perforator submental flap, which excludes the anterior belly of the digastric muscle, is a reliable technique described in the literature.
Most alt flaps, in our experience, require dissection of musculocutaneous perforator s and are infrequently supplied solely by septocutaneous perforators. The pharyngeal reconstruction should be included in code 15757, as it would for wherever the flap was inserted. The soft texture and light thickness of the flap sculptured in the best. Its utility in reconstruction following ablative head and neck procedures has been applied to various subsites including skin, lip, buccal mucosa, retromolar trigone, parotidectomy defects, and tongue. Threedimensional angiography of the submental artery. Additionally, with regard to flap viability, the vertical platysma flap is inferior to the submental artery island flap and free flaps as a result of its uncertain vascularity. These flaps are based on the submental artery, a branch of the facial artery, and have an anterior neck skin paddle which can be an inconspicuous donor site 8, 9. Plastic surgery perforator flaps thieme medical publishers. Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Submental artery perforator flaps have been used in the reconstruction of defects or deformities of the lower face. Freestyle local perforator flaps for facial reconstruction. Now in its second edition, the atlas of regional and free flaps for head and neck reconstruction delivers clear, heavily illustrated coverage of regional skin, muscle, and musculocutaneous flaps as well as donor sites from distant regions of the body where vascularized skin, muscle, bone, and nerves can be. Atlas of regional and free flaps for head and neck reconstruction. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this flap.
Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive. Better understanding of vascular anatomy and pattern of skin circulation has become possible by numerous cadaveric studies. Whether youve loved the book or not, if you give your honest and detailed thoughts then people will find new books that are right for them. A practical approach provides comprehensive, stepbystep instruction for flap raising and insetting for the head and neck region. Skin flap dissection atlas video library quality medical publishing. Penn annual flap dissection course penn flap course. For the first time all current information about existing perforator flaps has been gathered in one comprehensive work. Applied anatomy of the submental island flap and its.
The flap has a large caliber pedicle, but the anatomy of the perforator vessel or vessels can be variable. Both pedicle and microsurgical flaps will be covered. We are very pleased to announce the penn flap course to be held on august 14 16, 2020. Microsurgery medial sural artery perforator msap flap harvest duration. Dec 09, 2011 new chapters address the submental flap, ulnar forearm flap, anterolateral thigh flap, paramedian forehead flap, cervicofacial advancement flap, and perforator flaps. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. Innovative techniques in noma reconstructive surgery springerlink. Table 1 lists the principal features of the casuistry. The microsurgical techniques with free flaps are the gold standard in the immediate reconstruction of postcancer defects of the head and neck. The submental flap was first reported by martin et al. To obtain a thinner, more pliable flap and get a better oncological result, the submental artery perforator flap has been proposed, and to assess its feasibility for closure of defects after resection of cancers of the oral cavity we studied 20 patients, each of whom was treated in this way.
New chapters address the submental flap, ulnar forearm flap, anterolateral thigh flap, paramedian forehead flap, cervicofacial advancement flap, and perforator flaps. The patient underwent a second surgical operation under general anesthesia and nasotracheal intubation, consisting of a transverse incision in the neck and harvesting of a submental perforator flap, including the submental vein and artery in the flap. However, its role in composite defects involving the jaw is not clearly defined. The penn human tissue laboratory is a state of the art facility where we will have demonstrations of flap dissections by leaders in the field of reconstructive microsurgery. A flap vascularized by a septal perforator is called a septal perforator flap. Dec 20, 2011 the submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. Submental perforator flap for softtissue reconstruction. Chimeric stacked deep inferior epigastric perforator flap breast reconstruction. The submental island flap is a common choice for reconstruction of intraoral defects.
Program thursday, august 24, 2017 cadaver labs cadaver lab dissection the ohio state university hamilton hall room 256258 columbus, oh 43210 shuttle service provided from grand event center to hamilton hall, 7. This is an extremely useful local pedicle flap, or it can be used as a free flap. Suffix s is added if the flap is harvested based on direct septal or fasciocutaneous vessels. Other readers will always be interested in your opinion of the books youve read. Recently, application of this flap has been introduced in maxillofacial trauma patients. The principle that additional effort and time need to be spent to dissect the perforator out from between the muscle fibers to reduce the donor morbidity was the. Submental artery island flap was first described by martin et al.
The objective of this work is to show the benefits of the use of the submental flap in the maxillofacial reconstruction. It includes chapters and expert commentaries from more than 100 authors and. Penn annual flap dissection course penn flap course fresh. Discover a revolutionary approach to reconstructive surgery. Since its inception, the procedure has been successfully used in the reconstruction of the lower and mid face, 26 pharynx, 7 palate, 8,9 oral cavity, 10,11 and eye socket, 12 as well as the nose and columella. The flap dimensions needed are outline, with the perforator on the longitudinal axis of the flap. The submental island flap is a reliable alternative for reconstruction of head and neck defects in cancer patients. A comparative study between submandibularfacial artery island.
Reconstruction of lower face defect or deformity with submental. For the submental artery island flap though its perforator version, the submental artery perforator flap smapf, offers a technically feasible solution to unreliable. Submental flaps for facial and intraoral defect coverage were first described in 1993. Flaps and reconstructive surgery by fuchan wei and samir. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. Jan 12, 2015 the submental island flap was first mentioned in the literature by martin et al. Since this description, the submental island has struggled to gain a strong foothold as a reliable flap in the reconstruction of head and neck defects. True submental artery perforator flap for total soft. This twoday course will allow the participants to familiarize themselves with the full spectrum of skin flaps, including muscle, facial, bone, and perforator based flaps. Stacked deep inferior epigastric perforator flap breast reconstruction. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites. The perforator can be at the center, distal or proximal aspect of the flap, depending on the needed orientation in the recipient area.
The submental flap, based on a large branch of the facial artery, is an excellent flap. Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. Submental flap in tongue reconstruction reconstructive. Submental perforator flap for softtissue reconstruction in. The submental island flap for palatal reconstruction. A comparative study between submandibularfacial artery island flaps including perforator flap and submental artery perforator flap. Hair bearing nature of this flap in men makes it less appropriate. Since its description in 1990,1 the submental artery flap. Submental perforator flap reconstruction of a malignant. The submental perforator flap has been used for various traumatic and oncologic defects, and to the best of our knowledge this is the first case in the english literature of submental perforator flap reconstruction of a malignant melanoma defect.
Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. We are very pleased to announce the penn flap course to be held on august 1416, 2020 at the human tissue laboratory of the university of pennsylvania. Now in its second edition, the atlas of regional and free flaps for head and neck reconstruction delivers clear, heavily illustrated coverage of regional skin, muscle, and musculocutaneous flaps as well as donor sites from distant regions of the body where vascularized skin, muscle, bone, and nerves can be harvested and transferred. Threedimensional angiography of the submental artery perforator flap. This results in an ellipse with its anterior longitudinal arc skirting the lateral border of the latissimus. Indeed, controversy exists about the flaps interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over. The intraservice work of code 42950 is encompassed in code 15757, which includes harvesting a donor free flap, insetting the free flap at the recipient site using microsurgical technique, and closure of both donor and recipient sites. Half of the submental perforators were originated deep to abdm. For colossal defects in the mouth floor, the submental island flap should involve with the submandibular gland, anterior belly of digastric muscle and mylohyoid muscle. Baudet editorial comment use of the submental area as donor tissue for reconstruction of facial defects has depended on the description of the anatomy by these authors. Perforator flaps have evolved, and they have provided many new flaps with new pedicles all over the body presenting important advantages. Pharyngoplasty with free flap reconstruction karenzupko. The course will be held at dukes human fresh tissue laboratory, using fresh cadavers.
Perforator dissection can be difficult and tedious to the inexperienced microsurgeon. Each segment includes an introduction discussing why the flap is important and how its commonly used for reconstruction. Surgical atlas of perforator flaps free medical books. Submental flap surgery was first described by martin et al 1 in 1993. The submental island flap is a fantastic option for the reconstruction of defects in the head and neck extending from the oral cavity, oropharynx, hypopharynx, maxilla, as well as various sites in the face such as the parotid bed, chin, face, upper and lower lip, and in neck defects. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery. Fresh cadaver flap dissection course duke department of. Prefabricated superficial temporal fascia flap combined with a submental flap in. Perforator flaps are described according to the main artery of origin e. Submental artery island flap in reconstruction of hard palate. Surgical anatomy of vascularized submental lymph node flap. Nasolabial flaps were the first true perforator flaps in the face used to reconstruct perioral defects.
Introduction general principles of flap dissection head and neck submental artery perforator smap flap facial artery perforator fap. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. Ten years of experience with the submental flap evidencebased medicine. Suffix ap artery perforator signifies a true musculocutaneous perforator flap. Submental flap in tongue reconstruction reconstructive surgery dr shaji thomas, rcc trivandrum. Reconstruction of intraoral defects after resection of. With coverage of nearly twice the number of flaps as the previous edition, flaps and reconstructive surgery, 2nd edition provides trainees and practicing surgeons alike with the detailed, expert knowledge required to ensure optimal outcomes. From 1994 to 2008, we performed reconstruction with the submental flap in 47 patients affected by skin cancer of the face. The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. The submental island flap sif is a pedicled flap based upon the submental artery and vein. Reconstruction of intraoral defects after resection of cancer.
Advancing education, research, and quality of care for the head and neck oncology patient. Indeed, controversy exists about the flap s interference with an oncologically sound neck dissection a total of 21 patients with oral cavity cancers over a three year period were. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb and the trunk. The submental island flap is a viable reconstructive. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. Disruption of the critical perforator off the submental artery risks skin necrosis. Atlas of regional and free flaps for head and neck.