Reconstruction of the Head and Neck Region Using Lower Trapezius Musculocutaneous Flaps

Background Recent literature has indicated that free flaps are currently considered the preferred choice for head and neck reconstruction. However, head and neck cancer patients are frequently treated with chemoradiotherapy, which is often associated with a poor general and local condition, and thus, such patients are ineligible for free flap reconstruction. Therefore, other reconstruction modalities should be considered.

Methods We used lower trapezius musculocutaneous (LTMC) flap based on the dorsal scapular artery to reconstruct head and neck defects that arose from head and neck cancer in 8 patients. All of the patients had undergone preoperative chemoradiotherapy.

Results There were no complications except one case of partial flap necrosis; it was treated with secondary intention. Healing in the remaining patients was uneventful without hematoma, seroma, or infection. The donor sites were closed primarily.

Conclusions The LTMC flap is the preferred flap for a simple, reliable, large flap with a wide arc of rotation and minor donor-site morbidity. The authors recommend this versatile island flap as an alternative to microvascular free tissue transfer for the reconstruction of defects in the head and neck region, for patients that have undergone preoperative chemoradiotherapy.

Keywords

Head and neck neoplasms - Reconstructive surgical procedures - Chemoradiotherapy - Surgical flaps

This study was supported by a grant from the Chungnam National University Hospital Research Fund in 2011.

Publikationsverlauf

Eingereicht: 30. Juni 2012

Angenommen: 17. September 2012

Artikel online veröffentlicht:
01. Mai 2022

• REFERENCES

• 1 Choi EC, Kim CH, Kim SH. et al. The role of pectoralis major myocutaneous flap in the era of free flap. Korean J Head Neck Oncol 2001; 17: 190-193
• 2 Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg 1979; 63: 73-81
• 3 Pallua N, Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg 2000; 105: 842-851
• 4 Netterville JL, Wood DE. The lower trapezius flap. Vascular anatomy and surgical technique. Arch Otolaryngol Head Neck Surg 1991; 117: 73-76
• 5 Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67: 177-187
• 6 Mathes SJ, Nahai F. Clinical atlas of muscle and musculocutaneous flap. 1979. St. Louis: Mosby;
• 7 McCraw JB, Dibbell DG. Experimental definition of independent myocutaneous vascular territories. Plast Reconstr Surg 1977; 60: 212-220
• 8 McCraw JB, Dibbell DG, Carraway JH. Clinical definition of independent myocutaneous vascular territories. Plast Reconstr Surg 1977; 60: 341-352
• 9 Urken ML, Naidu RK, Lawson W. et al. The lower trapezius island musculocutaneous flap revisited. Report of 45 cases and a unifying concept of the vascular supply. Arch Otolaryngol Head Neck Surg 1991; 117: 502-511
• 10 Baek SM, Biller HF, Krespi YP. et al. The lower trapezius island myocutaneous flap. Ann Plast Surg 1980; 5: 108-114
• 11 Haas F, Weiglein A, Schwarzl F. et al. The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery. Plast Reconstr Surg 2004; 113: 1580-1590
• 12 Lynch JR, Hansen JE, Chaffoo R. et al. The lower trapezius musculocutaneous flap revisited: versatile coverage for complicated wounds to the posterior cervical and occipital regions based on the deep branch of the transverse cervical artery. Plast Reconstr Surg 2002; 109: 444-450
• 13 Angrigiani C, Grilli D, Karanas YL. et al. The dorsal scapular island flap: an alternative for head, neck, and chest reconstruction. Plast Reconstr Surg 2003; 111: 67-78
• 14 Tan KC, Tan BK. Extended lower trapezius island myocutaneous flap: a fasciomyocutaneous flap based on the dorsal scapular artery. Plast Reconstr Surg 2000; 105: 1758-1763
• 15 Ugurlu K, Ozcelik D, Huthut I. et al. Extended vertical trapezius myocutaneous flap in head and neck reconstruction as a salvage procedure. Plast Reconstr Surg 2004; 114: 339-350
• 16 Ariyan S. Further experiences with the pectoralis major myocutaneous flap for the immediate repair of defects from excisions of head and neck cancers. Plast Reconstr Surg 1979; 64: 605-612
• 17 Chiu ES, Liu PH, Friedlander PL. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg 2009; 124: 115-123