The lower trapezius musculocutaneous flap for head and neck reconstruction: Two decades of clinical experience

Kuang-Ling Ou, Yang-Hong Dai, Hsian-Jenn Wang, Tim-Mo Chen, Niann-Tzyy Dai, Shun-Cheng Chang, Shou-Cheng Deng, Yuan-Sheng Tzeng, Chih-Hsin Wang, Shyi-Gen Chen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: Microsurgical free flap has gained the popularity over pedicle flap nowadays in the reconstruction of head and neck. However, pedicled flaps remain a promising alternative and have a remarkable position in selected patients. This review study aimed to determine the reliability and versatility of the lower trapezius musculocutaneous flap for reconstructing complex defects in the head and neck. METHODS: Between 1993 and 2012, 22 male and 10 female patients underwent a total of 32 lower trapezius flap reconstructions for complex defects that included neoplasm extirpation (n = 21), radionecrosis (n = 6), dehisced laminectomy (n = 2), pressure sore (n = 2), and necrotizing fasciitis (n = 1). The most common site of defect was the perioral region, followed by the neck, posterior skull, back, temporal region, shoulder, and the upper arm. Flap design was based on the defect size and location, as well as the ability to close the donor site primarily and to preserve muscle function. Outcome has been evaluated by the hospital course, postoperative morbidity, mortality, resultant cosmetics, and function at donor and recipient sites. RESULTS: Stable wound coverage with total flap survival was achieved in 30 (93.75%) patients, 2 patients had partial flap necrosis which required flap reinsertion and skin graft coverage. All donor sites were closed primarily. Seroma developed in 2 (6.25%) patients, which were solved by needle aspiration. All muscle function was preserved. Eight patients died of their primary disease. CONCLUSIONS: For selected patients who have advanced stage cancer, surgical sequelae after free flap surgery, unable to tolerate microsurgery, or special defect location, pedicled lower trapezius musculocutaneous flap provides efficient and effective reconstruction for complex defects especially in the head and neck. Copyright © 2013 Lippincott Williams & Wilkins.
Original languageEnglish
Pages (from-to)S48-S54
JournalAnnals of Plastic Surgery
Volume71
Issue numberSUPPL.1
DOIs
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Myocutaneous Flap
Superficial Back Muscles
Neck
Head
Free Tissue Flaps
Tissue Donors
Necrotizing Fasciitis
Seroma
Muscles
Surgical Flaps
Laminectomy
Microsurgery
Pressure Ulcer
Temporal Lobe
Skull
Cosmetics
Needles
Neoplasms
Arm
Necrosis

Keywords

  • laminectomy
  • pressure sore
  • radionecrosis
  • squamous cell carcinoma
  • trapezius musculocutaneous flap
  • adult
  • aged
  • article
  • auditory canal
  • back muscle
  • case report
  • dermatofibrosarcoma protuberans
  • ear tumor
  • female
  • head and neck tumor
  • human
  • male
  • methodology
  • middle aged
  • neck dissection
  • plastic surgery
  • retrospective study
  • skin tumor
  • surgical flaps
  • tonsil tumor
  • very elderly
  • wound healing
  • young adult
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell
  • Dermatofibrosarcoma
  • Ear Canal
  • Ear Neoplasms
  • Female
  • Head and Neck Neoplasms
  • Humans
  • Male
  • Middle Aged
  • Neck Dissection
  • Reconstructive Surgical Procedures
  • Retrospective Studies
  • Skin Neoplasms
  • Superficial Back Muscles
  • Surgical Flaps
  • Tonsillar Neoplasms
  • Wound Healing
  • Young Adult

Cite this

The lower trapezius musculocutaneous flap for head and neck reconstruction: Two decades of clinical experience. / Ou, Kuang-Ling; Dai, Yang-Hong; Wang, Hsian-Jenn; Chen, Tim-Mo; Dai, Niann-Tzyy; Chang, Shun-Cheng; Deng, Shou-Cheng; Tzeng, Yuan-Sheng; Wang, Chih-Hsin; Chen, Shyi-Gen.

In: Annals of Plastic Surgery, Vol. 71, No. SUPPL.1, 2013, p. S48-S54.

Research output: Contribution to journalArticle

Ou, K-L, Dai, Y-H, Wang, H-J, Chen, T-M, Dai, N-T, Chang, S-C, Deng, S-C, Tzeng, Y-S, Wang, C-H & Chen, S-G 2013, 'The lower trapezius musculocutaneous flap for head and neck reconstruction: Two decades of clinical experience', Annals of Plastic Surgery, vol. 71, no. SUPPL.1, pp. S48-S54. https://doi.org/10.1097/SAP.0000000000000036
Ou, Kuang-Ling ; Dai, Yang-Hong ; Wang, Hsian-Jenn ; Chen, Tim-Mo ; Dai, Niann-Tzyy ; Chang, Shun-Cheng ; Deng, Shou-Cheng ; Tzeng, Yuan-Sheng ; Wang, Chih-Hsin ; Chen, Shyi-Gen. / The lower trapezius musculocutaneous flap for head and neck reconstruction: Two decades of clinical experience. In: Annals of Plastic Surgery. 2013 ; Vol. 71, No. SUPPL.1. pp. S48-S54.
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title = "The lower trapezius musculocutaneous flap for head and neck reconstruction: Two decades of clinical experience",
abstract = "BACKGROUND: Microsurgical free flap has gained the popularity over pedicle flap nowadays in the reconstruction of head and neck. However, pedicled flaps remain a promising alternative and have a remarkable position in selected patients. This review study aimed to determine the reliability and versatility of the lower trapezius musculocutaneous flap for reconstructing complex defects in the head and neck. METHODS: Between 1993 and 2012, 22 male and 10 female patients underwent a total of 32 lower trapezius flap reconstructions for complex defects that included neoplasm extirpation (n = 21), radionecrosis (n = 6), dehisced laminectomy (n = 2), pressure sore (n = 2), and necrotizing fasciitis (n = 1). The most common site of defect was the perioral region, followed by the neck, posterior skull, back, temporal region, shoulder, and the upper arm. Flap design was based on the defect size and location, as well as the ability to close the donor site primarily and to preserve muscle function. Outcome has been evaluated by the hospital course, postoperative morbidity, mortality, resultant cosmetics, and function at donor and recipient sites. RESULTS: Stable wound coverage with total flap survival was achieved in 30 (93.75{\%}) patients, 2 patients had partial flap necrosis which required flap reinsertion and skin graft coverage. All donor sites were closed primarily. Seroma developed in 2 (6.25{\%}) patients, which were solved by needle aspiration. All muscle function was preserved. Eight patients died of their primary disease. CONCLUSIONS: For selected patients who have advanced stage cancer, surgical sequelae after free flap surgery, unable to tolerate microsurgery, or special defect location, pedicled lower trapezius musculocutaneous flap provides efficient and effective reconstruction for complex defects especially in the head and neck. Copyright {\circledC} 2013 Lippincott Williams & Wilkins.",
keywords = "laminectomy, pressure sore, radionecrosis, squamous cell carcinoma, trapezius musculocutaneous flap, adult, aged, article, auditory canal, back muscle, case report, dermatofibrosarcoma protuberans, ear tumor, female, head and neck tumor, human, male, methodology, middle aged, neck dissection, plastic surgery, retrospective study, skin tumor, surgical flaps, tonsil tumor, very elderly, wound healing, young adult, Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell, Dermatofibrosarcoma, Ear Canal, Ear Neoplasms, Female, Head and Neck Neoplasms, Humans, Male, Middle Aged, Neck Dissection, Reconstructive Surgical Procedures, Retrospective Studies, Skin Neoplasms, Superficial Back Muscles, Surgical Flaps, Tonsillar Neoplasms, Wound Healing, Young Adult",
author = "Kuang-Ling Ou and Yang-Hong Dai and Hsian-Jenn Wang and Tim-Mo Chen and Niann-Tzyy Dai and Shun-Cheng Chang and Shou-Cheng Deng and Yuan-Sheng Tzeng and Chih-Hsin Wang and Shyi-Gen Chen",
note = "被引用次數:3 Export Date: 21 March 2016 CODEN: APCSD 通訊地址: Chen, S.-G.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Rd, Nei-Hu 114, Taipei, Taiwan; 電子郵件: shyigen@gmail.com 參考文獻: Mathes, S.J., Stevenson, T.R., Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap (1988) Am J Surg., 156, pp. 248-251; Yoon, S.K., Song, S.H., Kang, N., Reconstruction of the head and neck region using lower trapezius musculocutaneous flaps (2012) Arch Plast Surg., 39, pp. 626-630; Ensat, F., Schubert, H., Hladik, M., Soft tissue reconstruction in the extremities and the head and neck area using the anterolateral thigh free flap (2013) Oper Orthop Traumatol., 25, pp. 176-184; Fakhry, N., Chamorey, E., Michel, J., Salvage circular laryngopharyngectomy and radial forearm free flap for recurrent hypopharyngeal cancer (2013) Laryngoscope., 123, pp. 910-915; Baker, S.R., Microvascular free flaps in soft-Tissue augmentation of the head and neck (1986) Arch Otolaryngol Head Neck Surg., 112, pp. 733-737; Ariyan, S., The pectoralis major myocutaneous flap A versatile flap for reconstruction in the head and neck (1979) Plast Reconstr Surg., 63, pp. 73-81; El-Marakby, H.H., The reliability of pectoralis major myocutaneous flap in head and neck reconstruction (2006) J Egypt Natl Cancer Inst., 18, pp. 41-50; Netterville, J.L., Wood, D.E., The lower trapezius flap Vascular anatomy and surgical technique (1991) Arch Otolaryngol Head Neck Surg., 117, pp. 73-76; Chandrasekhar, B., Terz, J.J., Kokal, W.A., The inferior trapezius musculocutaneous flap in head and neck reconstruction (1988) Ann Plast Surg., 21, pp. 201-209; Cummings, C.W., Eisele, D.W., Coltrera, M.D., Lower trapezius myocutaneous island flap (1989) Arch Otolaryngol Head Neck Surg., 115, pp. 1181-1185; Baek, S.M., Biller, H.F., Krespi, Y.P., The lower trapezius island myocutaneous flap (1980) Ann Plast Surg., 5, pp. 108-114; Zachrisson, B.U., JCO/interviews dr bjorn u zachrisson on iatrogenic damage in orthodontic treatment (part 2) interview by sidney brandt (1978) J Clin Orthod., 12, pp. 208-220; Seyfer, A.E., The lower trapezius flap for recalcitrant wounds of the posterior skull and spine (1988) Ann Plast Surg., 20, pp. 414-418; Netterville, J.L., Panje, W.R., Maves, M.D., The trapezius myocutaneous flap Dependability and limitations (1987) Arch Otolaryngol Head Neck Surg., 113, pp. 271-281; Urken, M.L., Naidu, R.K., Lawson, W., The lower trapezius island musculocutaneous flap revisited. Report of 45 cases and a unifying concept of the vascular supply (1991) Arch Otolaryngol Head Neck Surg., 117, pp. 502-511; Bozola, A.R., Gasques, J.A., Carriquiry, C.E., The buccinator musculomucosal flap: Anatomic study and clinical application (1989) Plast Reconstr Surg., 84, pp. 250-257; Charles, G.A., Hamaker, R.C., Singer, M.I., Sternocleidomastoid myocutaneous flap (1987) Laryngoscope., 97, pp. 970-974; Chiu, E.S., Liu, P.H., Friedlander, P.L., Supraclavicular artery island flap for head and neck oncologic reconstruction: Indications, complications, and outcomes (2009) Plast Reconstr Surg., 124, pp. 115-123; Futrell, J.W., Johns, M.E., Edgerton, M.T., Platysma myocutaneous flap for intraoral reconstruction (1978) Am J Surg., 136, pp. 504-507; Iyer, N.G., Clark, J.R., Ashford, B.G., Internal mammary artery perforator flap for head and neck reconstruction (2009) ANZ J Surg., 79, pp. 799-803; Martin, D., Pascal, J.F., Baudet, J., The submental island flap: A new donor site. Anatomy and clinical applications as a free or pedicled flap (1993) Plast Reconstr Surg., 92, pp. 867-873; Maves, M.D., Panje, W.R., Shagets, F.W., Extended latissimus dorsi myocutaneous flap reconstruction of major head and neck defects (1984) Otolaryngol Head Neck Surg., 92, pp. 551-558; Napolitano, M., Mast, B.A., The nasolabial flap revisited as an adjunct to floor-of-mouth reconstruction (2001) Ann Plast Surg., 46, pp. 265-268; Varghese, B.T., Sebastian, P., Cherian, T., Nasolabial flaps in oral reconstruction: An analysis of 224 cases (2001) Br J Plast Surg., 54, pp. 499-503; Quillen, C.G., Shearin Jr., J.C., Georgiade, N.G., Use of the latissimus dorsi myocutaneous island flap for reconstruction in the head and neck area: Case report (1978) Plast Reconstr Surg., 62, pp. 113-117; Rudes, M., Bilic, M., Jurlina, M., Pectoralis major myocutaneous flap in the reconstructive surgery of the head and neckVour experience (2012) Coll Antropol., 36 (SUPPL. 2), pp. 137-142; Rapis, T., Zanakis, S.N., Letsa, I.F., Basal cell carcinoma of the posterior neck, reconstructed with lower trapezius island musculocutaneous flap Case report in an unusual site of occurrence (2003) J BUON., 8, pp. 397-401; Mathes, S.J., Nahai, F., Classification of the vascular anatomy of muscles: Experimental and clinical correlation (1981) Plast Reconstr Surg., 67, pp. 177-187; Bertotti, J.A., Trapezius-musculocutaneous island flap in the repair of major head and neck cancer (1980) Plast Reconstr Surg., 65, pp. 16-21; Conley, J., Use of composite flaps containing bone for major repairs in the head and neck (1972) Plast Reconstr Surg., 49, pp. 522-526; Panje, W.R., Myocutaneous trapezius flap (1980) Head Neck Surg., 2, pp. 206-212; Aviv, J.E., Urken, M.L., Lawson, W., The superior trapezius myocutaneous flap in head and neck reconstruction (1992) Arch Otolaryngol Head Neck Surg., 118, pp. 702-706; Demergasso, F., Piazza, M.V., Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: An original technique (1979) Am J Surg., 138, pp. 533-536; Guillamondegui, O.M., Larson, D.L., The lateral trapezius musculocutaneous flap: Its use in head and neck reconstruction (1981) Plast Reconstr Surg., 67, pp. 143-150; Ferbeyre-Binelfa, L., Lattissimus dorsi myocutaneous flap in head and neck surgery (2010) Cir Cir., 78, pp. 485-491; Haas, F., Pierer, G., Weiglein, A., The lower trapezius muscle island flap. Anatomic principles and clinical relevance (1999) Handchir Mikrochir Plast Chir., 31, pp. 15-20; Rosen, H.M., The extended trapezius musculocutaneous flap for cranio-orbital facial reconstruction (1985) Plast Reconstr Surg., 75, pp. 318-332",
year = "2013",
doi = "10.1097/SAP.0000000000000036",
language = "English",
volume = "71",
pages = "S48--S54",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "SUPPL.1",

}

TY - JOUR

T1 - The lower trapezius musculocutaneous flap for head and neck reconstruction: Two decades of clinical experience

AU - Ou, Kuang-Ling

AU - Dai, Yang-Hong

AU - Wang, Hsian-Jenn

AU - Chen, Tim-Mo

AU - Dai, Niann-Tzyy

AU - Chang, Shun-Cheng

AU - Deng, Shou-Cheng

AU - Tzeng, Yuan-Sheng

AU - Wang, Chih-Hsin

AU - Chen, Shyi-Gen

N1 - 被引用次數:3 Export Date: 21 March 2016 CODEN: APCSD 通訊地址: Chen, S.-G.; Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Rd, Nei-Hu 114, Taipei, Taiwan; 電子郵件: shyigen@gmail.com 參考文獻: Mathes, S.J., Stevenson, T.R., Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap (1988) Am J Surg., 156, pp. 248-251; Yoon, S.K., Song, S.H., Kang, N., Reconstruction of the head and neck region using lower trapezius musculocutaneous flaps (2012) Arch Plast Surg., 39, pp. 626-630; Ensat, F., Schubert, H., Hladik, M., Soft tissue reconstruction in the extremities and the head and neck area using the anterolateral thigh free flap (2013) Oper Orthop Traumatol., 25, pp. 176-184; Fakhry, N., Chamorey, E., Michel, J., Salvage circular laryngopharyngectomy and radial forearm free flap for recurrent hypopharyngeal cancer (2013) Laryngoscope., 123, pp. 910-915; Baker, S.R., Microvascular free flaps in soft-Tissue augmentation of the head and neck (1986) Arch Otolaryngol Head Neck Surg., 112, pp. 733-737; Ariyan, S., The pectoralis major myocutaneous flap A versatile flap for reconstruction in the head and neck (1979) Plast Reconstr Surg., 63, pp. 73-81; El-Marakby, H.H., The reliability of pectoralis major myocutaneous flap in head and neck reconstruction (2006) J Egypt Natl Cancer Inst., 18, pp. 41-50; Netterville, J.L., Wood, D.E., The lower trapezius flap Vascular anatomy and surgical technique (1991) Arch Otolaryngol Head Neck Surg., 117, pp. 73-76; Chandrasekhar, B., Terz, J.J., Kokal, W.A., The inferior trapezius musculocutaneous flap in head and neck reconstruction (1988) Ann Plast Surg., 21, pp. 201-209; Cummings, C.W., Eisele, D.W., Coltrera, M.D., Lower trapezius myocutaneous island flap (1989) Arch Otolaryngol Head Neck Surg., 115, pp. 1181-1185; Baek, S.M., Biller, H.F., Krespi, Y.P., The lower trapezius island myocutaneous flap (1980) Ann Plast Surg., 5, pp. 108-114; Zachrisson, B.U., JCO/interviews dr bjorn u zachrisson on iatrogenic damage in orthodontic treatment (part 2) interview by sidney brandt (1978) J Clin Orthod., 12, pp. 208-220; Seyfer, A.E., The lower trapezius flap for recalcitrant wounds of the posterior skull and spine (1988) Ann Plast Surg., 20, pp. 414-418; Netterville, J.L., Panje, W.R., Maves, M.D., The trapezius myocutaneous flap Dependability and limitations (1987) Arch Otolaryngol Head Neck Surg., 113, pp. 271-281; Urken, M.L., Naidu, R.K., Lawson, W., The lower trapezius island musculocutaneous flap revisited. Report of 45 cases and a unifying concept of the vascular supply (1991) Arch Otolaryngol Head Neck Surg., 117, pp. 502-511; Bozola, A.R., Gasques, J.A., Carriquiry, C.E., The buccinator musculomucosal flap: Anatomic study and clinical application (1989) Plast Reconstr Surg., 84, pp. 250-257; Charles, G.A., Hamaker, R.C., Singer, M.I., Sternocleidomastoid myocutaneous flap (1987) Laryngoscope., 97, pp. 970-974; Chiu, E.S., Liu, P.H., Friedlander, P.L., Supraclavicular artery island flap for head and neck oncologic reconstruction: Indications, complications, and outcomes (2009) Plast Reconstr Surg., 124, pp. 115-123; Futrell, J.W., Johns, M.E., Edgerton, M.T., Platysma myocutaneous flap for intraoral reconstruction (1978) Am J Surg., 136, pp. 504-507; Iyer, N.G., Clark, J.R., Ashford, B.G., Internal mammary artery perforator flap for head and neck reconstruction (2009) ANZ J Surg., 79, pp. 799-803; Martin, D., Pascal, J.F., Baudet, J., The submental island flap: A new donor site. Anatomy and clinical applications as a free or pedicled flap (1993) Plast Reconstr Surg., 92, pp. 867-873; Maves, M.D., Panje, W.R., Shagets, F.W., Extended latissimus dorsi myocutaneous flap reconstruction of major head and neck defects (1984) Otolaryngol Head Neck Surg., 92, pp. 551-558; Napolitano, M., Mast, B.A., The nasolabial flap revisited as an adjunct to floor-of-mouth reconstruction (2001) Ann Plast Surg., 46, pp. 265-268; Varghese, B.T., Sebastian, P., Cherian, T., Nasolabial flaps in oral reconstruction: An analysis of 224 cases (2001) Br J Plast Surg., 54, pp. 499-503; Quillen, C.G., Shearin Jr., J.C., Georgiade, N.G., Use of the latissimus dorsi myocutaneous island flap for reconstruction in the head and neck area: Case report (1978) Plast Reconstr Surg., 62, pp. 113-117; Rudes, M., Bilic, M., Jurlina, M., Pectoralis major myocutaneous flap in the reconstructive surgery of the head and neckVour experience (2012) Coll Antropol., 36 (SUPPL. 2), pp. 137-142; Rapis, T., Zanakis, S.N., Letsa, I.F., Basal cell carcinoma of the posterior neck, reconstructed with lower trapezius island musculocutaneous flap Case report in an unusual site of occurrence (2003) J BUON., 8, pp. 397-401; Mathes, S.J., Nahai, F., Classification of the vascular anatomy of muscles: Experimental and clinical correlation (1981) Plast Reconstr Surg., 67, pp. 177-187; Bertotti, J.A., Trapezius-musculocutaneous island flap in the repair of major head and neck cancer (1980) Plast Reconstr Surg., 65, pp. 16-21; Conley, J., Use of composite flaps containing bone for major repairs in the head and neck (1972) Plast Reconstr Surg., 49, pp. 522-526; Panje, W.R., Myocutaneous trapezius flap (1980) Head Neck Surg., 2, pp. 206-212; Aviv, J.E., Urken, M.L., Lawson, W., The superior trapezius myocutaneous flap in head and neck reconstruction (1992) Arch Otolaryngol Head Neck Surg., 118, pp. 702-706; Demergasso, F., Piazza, M.V., Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: An original technique (1979) Am J Surg., 138, pp. 533-536; Guillamondegui, O.M., Larson, D.L., The lateral trapezius musculocutaneous flap: Its use in head and neck reconstruction (1981) Plast Reconstr Surg., 67, pp. 143-150; Ferbeyre-Binelfa, L., Lattissimus dorsi myocutaneous flap in head and neck surgery (2010) Cir Cir., 78, pp. 485-491; Haas, F., Pierer, G., Weiglein, A., The lower trapezius muscle island flap. Anatomic principles and clinical relevance (1999) Handchir Mikrochir Plast Chir., 31, pp. 15-20; Rosen, H.M., The extended trapezius musculocutaneous flap for cranio-orbital facial reconstruction (1985) Plast Reconstr Surg., 75, pp. 318-332

PY - 2013

Y1 - 2013

N2 - BACKGROUND: Microsurgical free flap has gained the popularity over pedicle flap nowadays in the reconstruction of head and neck. However, pedicled flaps remain a promising alternative and have a remarkable position in selected patients. This review study aimed to determine the reliability and versatility of the lower trapezius musculocutaneous flap for reconstructing complex defects in the head and neck. METHODS: Between 1993 and 2012, 22 male and 10 female patients underwent a total of 32 lower trapezius flap reconstructions for complex defects that included neoplasm extirpation (n = 21), radionecrosis (n = 6), dehisced laminectomy (n = 2), pressure sore (n = 2), and necrotizing fasciitis (n = 1). The most common site of defect was the perioral region, followed by the neck, posterior skull, back, temporal region, shoulder, and the upper arm. Flap design was based on the defect size and location, as well as the ability to close the donor site primarily and to preserve muscle function. Outcome has been evaluated by the hospital course, postoperative morbidity, mortality, resultant cosmetics, and function at donor and recipient sites. RESULTS: Stable wound coverage with total flap survival was achieved in 30 (93.75%) patients, 2 patients had partial flap necrosis which required flap reinsertion and skin graft coverage. All donor sites were closed primarily. Seroma developed in 2 (6.25%) patients, which were solved by needle aspiration. All muscle function was preserved. Eight patients died of their primary disease. CONCLUSIONS: For selected patients who have advanced stage cancer, surgical sequelae after free flap surgery, unable to tolerate microsurgery, or special defect location, pedicled lower trapezius musculocutaneous flap provides efficient and effective reconstruction for complex defects especially in the head and neck. Copyright © 2013 Lippincott Williams & Wilkins.

AB - BACKGROUND: Microsurgical free flap has gained the popularity over pedicle flap nowadays in the reconstruction of head and neck. However, pedicled flaps remain a promising alternative and have a remarkable position in selected patients. This review study aimed to determine the reliability and versatility of the lower trapezius musculocutaneous flap for reconstructing complex defects in the head and neck. METHODS: Between 1993 and 2012, 22 male and 10 female patients underwent a total of 32 lower trapezius flap reconstructions for complex defects that included neoplasm extirpation (n = 21), radionecrosis (n = 6), dehisced laminectomy (n = 2), pressure sore (n = 2), and necrotizing fasciitis (n = 1). The most common site of defect was the perioral region, followed by the neck, posterior skull, back, temporal region, shoulder, and the upper arm. Flap design was based on the defect size and location, as well as the ability to close the donor site primarily and to preserve muscle function. Outcome has been evaluated by the hospital course, postoperative morbidity, mortality, resultant cosmetics, and function at donor and recipient sites. RESULTS: Stable wound coverage with total flap survival was achieved in 30 (93.75%) patients, 2 patients had partial flap necrosis which required flap reinsertion and skin graft coverage. All donor sites were closed primarily. Seroma developed in 2 (6.25%) patients, which were solved by needle aspiration. All muscle function was preserved. Eight patients died of their primary disease. CONCLUSIONS: For selected patients who have advanced stage cancer, surgical sequelae after free flap surgery, unable to tolerate microsurgery, or special defect location, pedicled lower trapezius musculocutaneous flap provides efficient and effective reconstruction for complex defects especially in the head and neck. Copyright © 2013 Lippincott Williams & Wilkins.

KW - laminectomy

KW - pressure sore

KW - radionecrosis

KW - squamous cell carcinoma

KW - trapezius musculocutaneous flap

KW - adult

KW - aged

KW - article

KW - auditory canal

KW - back muscle

KW - case report

KW - dermatofibrosarcoma protuberans

KW - ear tumor

KW - female

KW - head and neck tumor

KW - human

KW - male

KW - methodology

KW - middle aged

KW - neck dissection

KW - plastic surgery

KW - retrospective study

KW - skin tumor

KW - surgical flaps

KW - tonsil tumor

KW - very elderly

KW - wound healing

KW - young adult

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Squamous Cell

KW - Dermatofibrosarcoma

KW - Ear Canal

KW - Ear Neoplasms

KW - Female

KW - Head and Neck Neoplasms

KW - Humans

KW - Male

KW - Middle Aged

KW - Neck Dissection

KW - Reconstructive Surgical Procedures

KW - Retrospective Studies

KW - Skin Neoplasms

KW - Superficial Back Muscles

KW - Surgical Flaps

KW - Tonsillar Neoplasms

KW - Wound Healing

KW - Young Adult

U2 - 10.1097/SAP.0000000000000036

DO - 10.1097/SAP.0000000000000036

M3 - Article

VL - 71

SP - S48-S54

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - SUPPL.1

ER -