Perforator-supercharged occipitocervicopectoral flaps for lower face and neck reconstruction.

Background: The occipitocervicopectoral flap has a local skin pedicle in the occipital region, with the distal portion of the flap in the pectoral region. One disadvantage of the occipitocervicopectoral flap is its limited flap length. To overcome this disadvantage, a perforator supercharging technique was applied to enlarge the original flap length. The aims of this study are to present a clinical application of the perforator-supercharged occipitocervicopectoral flap for face and neck reconstruction and to discuss a perforator supercharging technique and perforator anatomy.

Methods: All perforator-supercharged occipitocervicopectoral flaps that were used for face and neck reconstructions were analyzed retrospectively.

Results: In all nine cases, the second internal mammary artery perforator was attached at the end of the occipitocervicopectoral flap and supercharged with the contralateral recipient facial artery vessels. The average flap size was 22.6 × 6.2 cm, without any flap loss. It was possible to cover a large defect extending to bilateral sides with thin and pliable local skin tissue. All patients were satisfied with functional and aesthetic results achieved postoperatively after 6 months.

Conclusions: The internal mammary artery perforator-supercharged occipitocervicopectoral flap can be considered a type of bipedicle perforator flap and can provide reliable flap vascularity. By using a perforator supercharging technique, we can adjust and enlarge the flap length tailored to the defect.

Clinical Question/level Of Evidence: Therapeutic, IV.