Free flap harvest from the infraumbilical region for head and neck reconstruction purposes: a retrospective cohort study.

The abdominal wall has showed many advantages as a donor site in head and neck reconstruction given its constant pattern of dominant perforators. Currently, standard design of the skin component of composite soft-tissue flaps recommended for head and neck reconstruction encompasses the lower and upper periumbilical region thus increasing the overall vascularization of the flap. We report on the safety of the harvest of abdominal soft-tissue free flaps from the infraumbilical region. A retrospective charts review was performed. Consecutive subjects who underwent microsurgical reconstruction of composite defects of the Head & Neck with infraumbilical free flaps between January 2008-January 2020 were enrolled. After surgery, patients were followed up at three-month intervals to evaluate the incidence of complications and the long-term outcome at the donor site. 25 patients underwent reconstruction with free flaps harvested from the lower abdomen. A total of 35 abdominal flaps (20 VRAM, 15 DIEAP) were performed; ten patients underwent bilateral flap harvest and abdominoplasty was performed to achieve direct closure.  Marginal abdominal skin necrosis occurred in 3 patients postoperatively. Abdominal bulge occurred in one case; neither hernia nor abdominal wall weakness were not encountered at a median follow-up of 12 months (IQR 6; 27). The results of the study confirm that the infraumbilical region is a safe donor area of free flaps for head and neck reconstruction that preserves abdominal wall firmness and improves ultimate functional and aesthetic outcomes at the donor site.