The reconstruction of soft tissue defects of cranioface using modified lower trapezius musculocutaneous flap

Chang, Suk Choo; Lee, Dong Chan

Abstract

Reconstruction of extensive soft tissue defect of the head and neck after or resection or injury has improved with advances in surgical techniques. Traditional local flap techniques are not easy to reconstruct the extensive soft tissue defects and irradiated or contaminated recipient beds. Then musculocutaneous flaps such as pectoralis major flap, trapezius flap, latissimus dorsi flap and sternocleidomastoid flap have been performed. These musculocutaneous flaps are effective in resurfacing the neck and lower face, for example, mandibular area but difficult to reconstruct the upper face and scalp and the result is poor. Other alternative flap used to cover this area is free flap, but this flap has many limitation too and therefore reconstructive surgeons have attempted to develop new flaps. There are three distinct musculocutaneous flaps, the superior, the lateral island, and the lower island flaps, that can be harvested from the trapezius muscle that are used in head and neck reconstruction. The lower trapezius musculocutaneous flap provides a long paddle of thin, pliable skin and muscle and offers the long are of rotation and thus the greater versatility of the three types of trapezius flaps. But this lower trapezius musculocutaneous flap has may problems to reconstruct the upper part of face and scalp by traditional method and has used mainly to resurface the neck and lower face. Thus, authors modified the procedure of lower trapezius flap and tried to reconstruct the upper part of face and scalp. The modification is that during the dissection, the trapezius muscle must be totally mobilized and the dorsal scapular artery must be preserved. By this procedure, blood flow can circulate effectively to the distal portion of flap and then modified flap has greater are of rotation and reliably reach higher portion of face and scalp. The operative results me that among the eight cases performed by modified lower trapezius musculocutaneouas flap, seven were reconstructed successfully, and remaining one presented partial flap necrosis and secondary procedure was needed. The functional defecits of donor site were minimal in all cases.