Buried deep inferior epigastric perforator flaps for complex head and neck contour defects

The deep inferior epigastric perforator (DIEP) flap is presented as a potential source of tissue for head and neck reconstruction. It has been sparingly reported for pharyngeal reconstruction and to provide a large bulk of skin but not previously described for buried contour defects. We present a retrospective study of a consecutive series of six buried DIEP flaps performed between 2005 and 2007 with a review of their indications, results, and complications. Three patient defects had previous radiation. All flaps were used in the delay setting as secondary reconstructions. Soft tissue defects addressed in this study were the result of a variety of different pathologies, including temporal fossa meningioma, fibrous dysplasia of the skull and orbit, nasopharyngeal carcinoma, neck scar repair, sinus cancer, and osteomyelitis. We report a 100% success rate with primary flap survival, secondary contouring, minimal donor site, provision of moldable bulk soft tissue fill, and ability to fillet and redistribute. Patient-reported satisfaction at 6 months and 1 year was good to excellent in all cases. We concluded that in select cases, the functional and aesthetic advantages of the DIEP flap for head and neck reconstruction of soft tissue defects are superior to implants, fillers, and nonvascularized fat grafts. During revisions, these flaps are amendable to liposuction as a contouring tool with portions that can be redistributed on pedicles. The subcutaneous fat of the DIEP flap has resilience that tends to last and retain its shape with maintenance of residual volume over muscle flaps.