Abstract：
BACKGROUND: Total or subtotal glossectomy defects cause significant functional deficits in swallowing and speech and subsequently impair patients\' quality of life (QOL). Recently, the profunda artery perforator (PAP) flap has emerged as a potential alternative for reconstructing extensive glossectomy defects. While previous studies assessing recovery of neurotized anterolateral thigh (ALT) flaps in head and neck reconstruction reported superior sensory recovery, improved swallow function, and improved overall patient satisfaction in patients with neurotized flaps vs. non-neurotized ALT flap reconstruction, PAP flap neurotization has not been described and systematically assessed in head and neck patients.
METHODS: Six patients underwent subtotal tongue reconstruction with neurotized PAP flaps at the authors\' institution from May 2022 until August 2023. A branch of the posterior femoral cutaneous nerve of the PAP flap was coaptated to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament, pain, and temperature assessments were conducted at 3, 6, and 12 months postoperatively on the neo-tongue. The MD Anderson speech and deglutition scales and the EORTC-QLQ-H&N35 were used to record functional outcomes and QOL.
RESULTS: The mean age was 69 ± 4 years, and the mean body mass index was 25 ± 7 kg/m2. Neo-tongue median 2-point discrimination at the tip improved from >10 mm at 3 months to 6 mm at 12 months. All patients had protective pain and temperature perception at the neo-tongue tip at the 6-month follow-up. Speech and swallowing functions were similar at the 12-month follow-up to data on neurotized ALT flaps from literature. No neuropathic pain was reported at the donor site at the 6-month follow-up.
CONCLUSIONS: This is the first case series of PAP flap neurotization in head and neck patients, suggesting potential functional advantages with minimal donor-site morbidity.
METHODS: V Case Series.
METHODS: Six patients underwent subtotal tongue reconstruction with neurotized PAP flaps at the authors\' institution from May 2022 until August 2023. A branch of the posterior femoral cutaneous nerve of the PAP flap was coaptated to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament, pain, and temperature assessments were conducted at 3, 6, and 12 months postoperatively on the neo-tongue. The MD Anderson speech and deglutition scales and the EORTC-QLQ-H&N35 were used to record functional outcomes and QOL.
RESULTS: The mean age was 69 ± 4 years, and the mean body mass index was 25 ± 7 kg/m2. Neo-tongue median 2-point discrimination at the tip improved from >10 mm at 3 months to 6 mm at 12 months. All patients had protective pain and temperature perception at the neo-tongue tip at the 6-month follow-up. Speech and swallowing functions were similar at the 12-month follow-up to data on neurotized ALT flaps from literature. No neuropathic pain was reported at the donor site at the 6-month follow-up.
CONCLUSIONS: This is the first case series of PAP flap neurotization in head and neck patients, suggesting potential functional advantages with minimal donor-site morbidity.
METHODS: V Case Series.
摘要：
背景：全或次全舌切除术缺陷会导致吞咽和言语功能严重缺陷，进而损害患者的生活质量（QOL）。最近,深动脉穿支(PAP)皮瓣已成为重建广泛舌切除术缺损的潜在替代方法.虽然先前的研究评估神经化股前外侧（ALT）皮瓣在头颈部重建中的恢复报告了较好的感觉恢复，改善吞咽功能，并改善了神经化皮瓣患者的总体患者满意度与非神经化ALT皮瓣重建,尚未对头颈部患者的PAP皮瓣神经化进行描述和系统评估。
方法：从2022年5月至2023年8月，6例患者在作者机构接受了神经化PAP皮瓣的次全舌头重建。PAP皮瓣的股后皮神经分支与舌神经结合。两点歧视，Semmes-Weinstein单丝,疼痛,术后3个月,6个月和12个月对新舌进行体温评估.MDAnderson言语和吞咽量表以及EORTC-QLQ-H和N35用于记录功能结果和生活质量。
结果：平均年龄为69±4岁，平均体重指数为25±7kg/m2。新舌尖端的中位数2点辨别从3个月时的>10毫米提高到12个月时的6毫米。在6个月的随访中，所有患者的新舌尖均具有保护性疼痛和温度感知。在12个月的随访中，言语和吞咽功能与文献中神经化ALT皮瓣的数据相似。在6个月的随访中，供体部位没有神经性疼痛的报道。
结论：这是头颈部患者PAP皮瓣神经化的首例系列病例，提示潜在的功能优势与最小的供体部位发病率。
方法：VCase系列。
方法：从2022年5月至2023年8月，6例患者在作者机构接受了神经化PAP皮瓣的次全舌头重建。PAP皮瓣的股后皮神经分支与舌神经结合。两点歧视，Semmes-Weinstein单丝,疼痛,术后3个月,6个月和12个月对新舌进行体温评估.MDAnderson言语和吞咽量表以及EORTC-QLQ-H和N35用于记录功能结果和生活质量。
结果：平均年龄为69±4岁，平均体重指数为25±7kg/m2。新舌尖端的中位数2点辨别从3个月时的>10毫米提高到12个月时的6毫米。在6个月的随访中，所有患者的新舌尖均具有保护性疼痛和温度感知。在12个月的随访中，言语和吞咽功能与文献中神经化ALT皮瓣的数据相似。在6个月的随访中，供体部位没有神经性疼痛的报道。
结论：这是头颈部患者PAP皮瓣神经化的首例系列病例，提示潜在的功能优势与最小的供体部位发病率。
方法：VCase系列。
