ORIGINAL ARTICLE ADIPOFASCIAL PERFORATOR FLAPS FOR ‘‘AESTHETIC’’ HEAD AND NECK RECONSTRUCTION Matthew M. Hanasono, MD, Roman J. Skoracki, MD, Amanda K. Silva, BA, Peirong Yu, MD Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. E-mail: mhanasono@mdanderson.org Accepted 6 September 2010 Published online 28 December 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/hed.21637 Abstract: Background. Most head and neck reconstruc- tions are performed for wound closure or functional rehabilita- tion with aesthetic restoration being an important but secondary consideration. Methods. Contour deformities in 40 patients undergoing head and neck resections were reconstructed immediately with adipofascial perforator flaps, including 37 anterolateral thigh and 3 deep inferior epigastric perforator flaps. Results. Reconstructions could be grouped into 1 of 3 defect areas: temporal fossa (n ¼ 3), malar cheek (n ¼ 13), and parotid-mastoid (n ¼ 24). The mean time needed for reconstruction in excess of the oncologic resection was 3.1 hours. There were no flap losses. In no case did a complica- tion delay adjuvant therapy and no patient experienced a decrease in level of activity related to donor site morbidity. Conclusion. Immediate restoration of facial contour with adipofascial perforator flaps is warranted in head and neck oncologic patients to help improve self-image and maintain quality of life. V V C 2010 Wiley Periodicals, Inc. Head Neck 33: 1513–1519, 2011 Keywords: adipofascial free flap; perforator flap; anterolateral thigh free flap; deep inferior epigastric perforator flap; head and neck reconstruction Most reconstructive efforts after the resection of head and neck tumors focus on wound coverage and the res- toration of function whereas the aesthetic result remains an important but secondary goal. However, few would argue that facial appearance is central to a patient’s self-image and perception by others. Contem- porary microsurgery has reached a level at which the goal should now turn to maximizing not only functional results but aesthetic form as well, while at the same time minimizing donor site morbidity. We present a series of adipofascial free flap recon- structions performed at the time of oncologic resection with the primary intention of restoring esthetic facial contour. These flaps were harvested as perforator flaps, minimizing functional impairment of the donor site. Our hypothesis was that such reconstructions could be performed with only a modest increase in op- erative time and a minimal risk for complications and donor site morbidity that might delay the administra- tion of adjuvant therapy. PATIENTS AND METHODS A retrospective study of 40 consecutive pa- tients undergoing adipofascial perforator flap recon- struction for restoration of contour performed by the authors (M.M.H., R.J.S., and P.Y.) immediately after resection of various head and neck cancers at The Uni- versity of Texas MD Anderson Cancer Center between July 2005 and June 2009 was performed. Institutional review board approval was obtained before undertaking this study. Data including demographic information, surgical details, operative times, length of hospital stays, postoperative complications, and information regarding cancer recurrence were collected. Patients were selected to undergo reconstruction with adipofascial free flaps based on medical assess- ment and oncologic prognosis. Those who were deemed to be at high risk for a major medical compli- cation, as judged by an assessment performed by in- ternal medicine and cardiology staff at our institution, and patients undergoing resection for pal- liative rather than curative intent, did not undergo adipofascial free flap reconstruction in this series. Flaps in this series were harvested as previously described, except that the epidermis and dermis were either not included in small flaps, or removed and dis- carded in larger flaps where there would be excess skin at the donor site after adipofascial tissue harvest. 1–4 Flaps were harvested as perforator flaps, sparing mus- cle. Flap choices were made based on the available adi- pose tissue volume available as judged by examination of the patient’s body habitus. When adequate tissue was available at both sites, the choice was made based on the surgeon’s (or patient’s) preference. Fascia was included with the flaps and used to suspend the flaps to underlying fixed structures, such as periosteum, to prevent flap ptosis. In this series, free flap harvest was routinely begun simultaneously with the resection using a 2-team approach to minimize operative time. Correspondence to: M. M. Hanasono V V C 2010 Wiley Periodicals, Inc. Adipofascial Free Flaps HEAD & NECK—DOI 10.1002/hed October 2011 1513