[Design and application of the superior thyroid artery perforator flap]

Objective: To evaluate the design and application of the superior thyroid artery perforator flap (STAPF) for reconstruction after head and neck oncological resection. Methods: A retrospective analysis was performed on 24 consecutive patients (22 men, 2 women; age 40-72 years) treated at Hunan Cancer Hospital between June 2018 and December 2023. Their primary tumors included buccal carcinoma (n=7), tongue carcinoma (n=8), oropharyngeal carcinoma (n=2), floor-of-mouth carcinoma (n=3), laryngeal carcinoma (n=3), and hypopharyngeal carcinoma (n=1). Flap design, venous drainage strategy, and postoperative outcomes were assessed. SPSS 19.0 software was used for statistical analysis. Results: Flap dimensions were length of 9.4±0.5 cm, width of 3.3±0.6 cm, thickness of 0.5±0.2 cm, and pedicle length of 7.3±0.6 cm. Fifteen flaps were based on a single perforator (diameter ≥0.5 mm), whereas, nine fascial flaps incorporated multiple perforators (capillary diameter ≤0.5 mm). Venous drainage routes were as follows: superior thyroid vein (n=12, retrograde in 3), facial vein (n=5, all retrograde), anterior jugular vein (n=4, retrograde in 1), and external jugular vein (n=3, retrograde in 2). All 24 flaps survived completely. Donor sites were closed primarily and all cervical wounds healed. No flap-related complications, inculding orocutaneous, pharyngocutaneous, laryngocutaneous fistula and wound infection, were observed. Final pathologic stages were T1N0M0 (n=2), T2N0M0 (n=16), T2N1M0 (n=3), and T3N0M0 (n=3). With follow-up of 12-46 months, aside from one patient with tongue cancer died of contralateral cervical and parapharyngeal lymph-node metastases at 6 months, others remained disease-free. Patients with laryngeal or hypopharyngeal carcinoma had their tracheostomy tubes removed within 4 weeks postoperatively. Conclusion: STAPF offers flexible design, with minimal donor-site morbidity and low functional impairment. It is particularly advantageous for reconstruction of small-to-moderate defects following head and neck tumor ablation.