Surgical outcomes of profunda artery perforator flap in head and neck reconstruction: A systematic review and meta-analysis.
PAP flap
head and neck cancer
microsurgery
perforator flap
surgical complication
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
30 Jul 2024
30 Jul 2024
Historique:
revised:
05
06
2024
received:
10
04
2024
accepted:
13
07
2024
medline:
31
7
2024
pubmed:
31
7
2024
entrez:
31
7
2024
Statut:
aheadofprint
Résumé
This study aims to evaluate the efficacy of the profunda artery perforator (PAP) flap in head and neck reconstruction. A single arm meta-analysis was performed for flap survival rate (primary outcome), reoperation for major complication, and overall complication rates (secondary outcomes). The search strategy yielded a total of 295 potentially relevant publications, of which 13 were included. A total of 305 patients (males: 80.8%, n = 232/281), with a median age of 56.1 years (n = 305/305; 95% CI 53.9-63), who underwent a total of 307 PAP flap reconstructions for head and neck defects were included. Flap survival rate was 100% (n = 306/307; 95% CI 99.6%-100%), with a reoperation rate for major complications of 3.7% (n = 15/307; 95% CI 1.85%-6.1%) and an overall complication rate of 26.5% (n = 92/307; 95% CI 15.7%-38.9%). Notable postoperative complications included wound dehiscence (n = 15/307, 4.9%), delayed healing (n = 14/307, 4.6%), and wound infection (n = 12/307, 3.9%). Partial flap necrosis and hematoma occurred in 2.6% of cases (n = 8/307), while arterial and venous thrombosis were documented in 0.7% (n = 2/307) and 1.3%, respectively (n = 4/307). The application of the PAP flap in head and neck reconstructions showed several favorable aspects, such as an exceptionally low flap failure rate, versatility in achieving variable dimensions, and a relatively low incidence of complications. PAP flap might be considered as a compelling alternative to the traditionally employed soft tissue free flaps in head and neck reconstruction.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Head & Neck published by Wiley Periodicals LLC.
Références
Chang EI. Alternate soft‐tissue free flaps for head and neck reconstruction: the next generation of workhorse flaps. Plast Reconstr Surg. 2023;152(1):184‐193. doi:10.1097/PRS.0000000000010143
Saint‐Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg. 2009;123(4):132e. doi:10.1097/PRS.0b013e31819f2c6a
Smith RK, Wykes J, Martin DT, Niles N. Perforator variability in the anterolateral thigh free flap: a systematic review. Surg Radiol Anat. 2017;39(7):779‐789. doi:10.1007/s00276‐016‐1802‐y
Lee YC, Chen WC, Chou TM, Shieh SJ. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg. 2015;135(4):1097‐1107. doi:10.1097/PRS.0000000000001103
Wu JCW, Huang JJ, Tsao CK, Abdelrahman M, Kolios G, Cheng MH. Comparison of posteromedial thigh profunda artery perforator flap and anterolateral thigh perforator flap for head and neck reconstruction. Plast Reconstr Surg. 2016;137(1):257‐266. doi:10.1097/PRS.0000000000001880
Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42(6):645‐648. doi:10.1016/0007‐1226(89)90075‐1
Mardini S, Tsai FC, Wei FC. The thigh as a model for free style free flaps. Clin Plast Surg. 2003;30(3):473‐480. doi:10.1016/s0094‐1298(03)00047‐6
Qian Y, Li G, Zang H, et al. A systematic review and meta‐analysis of free‐style flaps: risk analysis of complications. Plast Reconstr Surg Glob Open. 2018;6(2):e1651. doi:10.1097/GOX.0000000000001651
Cho MJ, Teotia SS, Haddock NT. Classification and management of donor‐site wound complications in the profunda artery perforator flap for breast reconstruction. J Reconstr Microsurg. 2020;36(2):110‐115. doi:10.1055/s‐0039‐1697903
Allen RJ, Haddock NT, Ahn CY, Sadeghi A. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg. 2012;129(1):16e‐23e. doi:10.1097/PRS.0b013e3182363d9f
Liu SW, Hanick AL, Meleca JB, et al. The profunda artery perforator flap for head and neck reconstruction. Am J Otolaryngol. 2023;44(2):103772. doi:10.1016/j.amjoto.2022.103772
Ito R, Huang JJ, Wu JCW, Lin MCY, Cheng MH. The versatility of profunda femoral artery perforator flap for oncological reconstruction after cancer resection—clinical cases and review of literature. J Surg Oncol. 2016;114(2):193‐201. doi:10.1002/jso.24294
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. doi:10.1371/journal.pmed.1000100
NICE. Methods for the Development of NICE Public Health Guidance. 3rd ed. National Institute for Health and Care Excellence; 2012:284.
Sterne JAC, Sutton AJ, Ioannidis JPA, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta‐analyses of randomised controlled trials. BMJ Online. 2011;343(7818):1‐8. doi:10.1136/bmj.d4002
McGrath S, Zhao XF, Qin ZZ, Steele R, Benedetti A. One‐sample aggregate data meta‐analysis of medians. Stat Med. 2019;38(6):969‐984. doi:10.1002/sim.8013
Copas JB, Malley PF. A robust P‐value for treatment effect in meta‐analysis with publication bias. 2008;4267‐4278. doi:10.1002/sim.3284
Loureiro LVM, Victor EDS, Callegaro‐Filho D, et al. Minimizing the uncertainties regarding the effects of delaying radiotherapy for glioblastoma: a systematic review and meta‐analysis. Radiother Oncol. 2016;118(1):1‐8. doi:10.1016/j.radonc.2015.11.021
Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10(1):101‐129.
Jackson D, White IR, Riley RD. Quantifying the impact of between‐study heterogeneity in multivariate meta‐analyses. Stat Med. 2012;31(29):3805‐3820. doi:10.1002/sim.5453
Viechtbauer W, Cheung MWL. Outlier and influence diagnostics for meta‐analysis. Res Synth Methods. 2010;1(2):112‐125. doi:10.1002/jrsm.11
Baujat B, Mahé C, Pignon JP, Hill C. A graphical method for exploring heterogeneity in meta‐analyses: application to a meta‐analysis of 65 trials. Stat Med. 2002;21(18):2641‐2652. doi:10.1002/sim.1221
Egger M, Smith GD, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. Br Med J. 1997;315(7109):629‐634. doi:10.1136/bmj.315.7109.629
Balduzzi S, Rücker G, Schwarzer G. How to perform a meta‐analysis with R: a practical tutorial. Evid Based Ment Health. 2019;22(4):153‐160. doi:10.1136/ebmental‐2019‐300117
Yao CMK, Jozaghi Y, Danker S, et al. The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect. Microsurgery. 2023;43(4):309‐315. doi:10.1002/micr.30997
Ciudad P, Huang TCT, Manrique OJ, et al. Expanding the applications of the combined transverse upper gracilis and profunda artery perforator (TUGPAP) flap for extensive defects. Microsurgery. 2019;39(4):316‐325. doi:10.1002/micr.30413
Fernández‐Riera R, Hung SY, Wu JCW, Tsao CK. Free profunda femoris artery perforator flap as a first‐line choice of reconstruction for partial glossectomy defects. Head Neck. 2017;39(4):737‐743. doi:10.1002/hed.24675
Heredero S, Sanjuan A, Falguera MI, Dean A, Ogledzki M. The thin profunda femoral artery perforator flap for tongue reconstruction. Microsurgery. 2020;40(2):117‐124. doi:10.1002/micr.30485
Iida T, Yoshimatsu H, Karakawa R, Kanayama K, Harima M, Okazaki M. Additional venous anastomosis in free profunda artery perforator flap transfer using the posterior accessory saphenous vein. J Plast Reconstr Aesthetic Surg. 2019;72(12):1936‐1941. doi:10.1016/j.bjps.2019.09.013
Ismail T, Padilla P, Kurlander DE, et al. Profunda artery perforator flap tongue reconstruction: an effective and safe alternative to the anterolateral thigh flap. Plast Reconstr Surg. 2023;27:1191e‐1200e. doi:10.1097/PRS.0000000000010890
Kehrer A, Hsu MY, Chen YT, Sachanandani NS, Tsao CK. Simplified profunda artery perforator (PAP) flap design using power Doppler ultrasonography (PDU): a prospective study. Microsurgery. 2018;38(5):512‐523. doi:10.1002/micr.30266
Largo RD, Bhadkamkar MA, Asaad M, et al. The profunda artery perforator flap: a versatile option for head and neck reconstruction. Plast Reconstr Surg. 2021;147(6):1401‐1412. doi:10.1097/PRS.0000000000007977
Ma C, Gao W, Zhu D, et al. Profunda artery perforator flaps from the posteromedial region of the thigh for head and neck reconstruction. Otolaryngol Head Neck Surg. 2023;168(3):345‐356. doi:10.1177/01945998221109145
Scaglioni MF, Kuo YR, Yang JCS, Chen YC. The posteromedial thigh flap for head and neck reconstruction: anatomical basis, surgical technique, and clinical applications. Plast Reconstr Surg. 2015;136(2):363‐375. doi:10.1097/PRS.0000000000001414
Microsurgical free flap in head and neck reconstruction‐Wong‐2010‐Head & Neck‐Wiley online library. https://onlinelibrary.wiley.com/doi/abs/10.1002/hed.21284. Accessed March 7, 2024
Hanasono MM. Reconstructive surgery for head and neck cancer patients. Adv Med. 2014;2014:e795483. doi:10.1155/2014/795483
Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir. 2002;34(4):239‐244. doi:10.1055/s‐2002‐36290
Jackson I, Urken ML. Multidisciplinary head and neck reconstruction: a defect‐oriented approach. Eur J Plast Surg. 2010;33(2):115. doi:10.1007/s00238‐009‐0379‐7
Atzeni M, Salzillo R, Haywood R, Persichetti P, Figus A. Breast reconstruction using the profunda artery perforator (PAP) flap: technical refinements and evolution, outcomes, and patient satisfaction based on 116 consecutive flaps. J Plast Reconstr Aesthet Surg. 2022;75(5):1617‐1624. doi:10.1016/j.bjps.2021.11.085
Jo T, Jeon DN, Han HH. The PAP flap breast reconstruction: a practical option for slim patients. J Reconstr Microsurg. 2022;38(1):27‐33. doi:10.1055/s‐0041‐1727200