Lower Trapezius Island Musculocutaneous Flap for Reconstruction of Occipitotemporal Wounds after Posterior and Lateral Skullbase Surgery

Background: Scalp defects that result from intracranial and skull base surgery can present a significant reconstructive challenge. In these cases, the regional blood supply to the tissues has often been compromised by prior incisions, radiation, or trauma. In addition, the presence of surgical hardware or bony defects can further complicate management. These factors often preclude healing by secondary intention, primary closure, skin grafts, or local advancement-rotation flaps. In these situations, complex reconstruction is frequently used to transfer well-vascularized tissue into the wound bed. The use of free flaps has been well-described for this problem. Despite their effectiveness, they do present some inherent risks and difficulties. These include prolonged operative times, donor-site morbidity, the need for microvascular expertise, and a requirement for specialized postoperative care. In certain situations, a regional pedicled flap may be a suitable alternative.

Objective: To report our experience using trapezius flaps to close complex occipitotemporal wounds that developed after posterior and lateral skull base or intracranial procedures.

Methods: 8 patients were identified. Their medical records were reviewed. Their clinical courses were described. We include a discussion of the relevant surgical anatomy and operative technique.

Results: The flap success rate was 100%. All wounds were repaired in 1 stage. There was no breakdown noted after several years of follow-up. The donor sites were all closed primarily. No patient suffered any clinically-significant functional or cosmetic morbidity.

Conclusion: The trapezius flap provides a reliable option for reconstruction of chronic wounds that develop after posterior or lateral intracranial and skull base operations. All surgeons who reconstruct wounds in the head and neck region, even those without microvascular expertise, should consider having this technique in their armamentarium.