Reconstruction of Head and Neck Defects with Lower Trapezius Myocutaneus Flap

Main Article Content

Somesh Mozumder
Shirish Dubey
Kinshuk Chatterjee
Priyadarshan Kumar
Ankit Khandelwal
Aniruddha Dam
Anup Kumar Bhowmick

Abstract

Introduction


 High lateral and posteriorly based defects are challenging to reconstruct as mobilization of conventional pedicled flaps is difficult. This study was done to evaluate the usefulness of lower trapezius myocutaneous flap (LTMC) in selected cases as a reconstructive alternative to other pedicled flaps which have positional and technical disadvantages and/or in cases where free flap is not possible.


Materials and Methods


Ten cases of locally advanced (T3 and T4) high and laterally placed head and neck carcinoma (8 cases of SCC involving posterior scalp, ear lobule, skin anterior to tragus and 2 cases of locally advanced salivary gland malignancies involving parotid glands) irrespective of sex had been selected. Due to non-availability of plastic surgeon in the institute none of the patient could be subjected to free flap reconstruction. All the patients received post operative adjuvant radiotherapy and were followed up on a monthly basis for six months at least.


Results


                     Out of total 10 cases 5 underwent wound infection and dehiscence at recipient site. In 3 cases there were donor site seroma. In 2 cases healing was uneventful.  However in all cases the flap was healthy and flap survival was 100%. There was no flap contracture in long term follow up.


Conclusion                      


The LTMC flap is ideal for mentioned defects because of its anatomical location, abundant blood flow, minor donor-site morbidity, and long pedicle. The LTMC flap, though less commonly used, is a precious option in situations where free flaps and other pedicled flaps are not feasible.

Article Details

How to Cite
1.
Mozumder S, Dubey S, Chatterjee K, Kumar P, Khandelwal A, Dam A, Bhowmick AK. Reconstruction of Head and Neck Defects with Lower Trapezius Myocutaneus Flap. BJOHNS [Internet]. 2020Jul.27 [cited 2024Nov.23];26(2):144-9. Available from: https://bjohns.in/journal3/index.php/bjohns/article/view/198
Section
Our experience
Author Biographies

Somesh Mozumder, Chittaranjan National Cancer Institute, Kolkatac

Senior Resident

Dept. of E.N.T & Head & Neck oncology

Shirish Dubey

Consultant Maxillofacial surgeon (MDS)

Kinshuk Chatterjee, CHITTARANJAN NATIONAL CANCER INSTITUTE. KOLKATA

Senior Resident

Dept. of E.N.T & Head & Neck oncology

Priyadarshan Kumar, CHITTARANJAN NATIONAL CANCER INSTITUTE. KOLKATA

Junior Resident

Dept. of E.N.T & Head & Neck oncology

Ankit Khandelwal, CHITTARANJAN NATIONAL CANCER INSTITUTE. KOLKATA

Clinical Fellow

Dept. of E.N.T & Head & Neck oncology

Aniruddha Dam, CHITTARANJAN NATIONAL CANCER INSTITUTE. KOLKATA

H.O.D & Specialist grade - I

Dept. of E.N.T & Head & Neck oncology

Anup Kumar Bhowmick, CHITTARANJAN NATIONAL CANCER INSTITUTE. KOLKATA

Specialist grade - I

Dept. of E.N.T & Head & Neck oncology

References

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; 17:190-3

Ariyan S. The pectoralis major myocutaneous flap. A versatile flap for reconstruction in the head and neck. Plast Reconstr Surg. 1979; 63:73-81

Pallua N, Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plast Reconstr Surg. 2000; 105:842-51

Ou KL, Dai YH, Wang HJ, et al. The lower trapezius musculocutaneous flap for head and neck reconstruction: two decades of clinical experience. Ann Plast Surg. 2013;71 Suppl 1:S48-54

Netterville JL, Wood DE. The lower trapezius flap. Vascular anatomy and surgical technique. Arch Otolaryngol Head Neck Surg. 1991; 117:73-6

Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg. 1981; 67:177-87

Mathes SJ, Nahai F. Clinical atlas of muscle and musculocutaneous flap. St. Louis: Mosby; 1979

McCraw JB, Dibbell DG. Experimental definition of independent myocutaneous vascular territories. Plast Reconstr Surg. 1977; 60:212-20

McCraw JB, Dibbell DG, Carraway JH. Clinical definition of independent myocutaneous vascular territories. Plast Reconstr Surg. 1977; 60:341-52

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; 117:502-11

Baek SM, Biller HF, Krespi YP, et al. The lower trapezius island myocutaneous flap. Ann Plast Surg. 1980; 5:108-14

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; 113:1580-90

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; 109:444-50

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; 11:67-78

Tan KC, Tan BK. Extended lower trapezius island myocutaneous flap: a fasciomyocutaneous flap based on the dorsal scapular artery. Plast Reconstr Surg. 2000; 105:1758-63

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; 114:339-50

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; 64:605-12

Chiu ES, Liu PH, Friedlander PL. Supraclavicular artery island flap for head and neck oncologic reconstruction: indications, complications, and outcomes. Plast Reconstr Surg. 2009; 124:115-23.

Most read articles by the same author(s)