EXTENDED ANTERIOR THIGH FLAPS FOR REPAIR OF MASSIVE CERVICAL DEFECTS INVOLVING PHARYNGOESOPHAGUS AND SKIN - AN INTRODUCTION TO THE MOSAIC FLAP PRINCIPLE

''Mosaic'' flaps, i.e., connected anteromedial thigh-groin flaps, and connected anterolateral thigh-medial thigh flaps, the pedicles of whic h are the perforators of the lateral circumflex femoral system, the su perficial circumflex iliac vessels, and the perforators from the femor al vessels are used to repair cervical skin defects involving the phar yngoesophagus. Although they appear to be similar to ''siamese'' flaps , these mosaic flaps are a new concept because they consist of two adj acent flaps that are simultaneously elevated with double pedicles incl uding the lateral circumflex femoral system. The pedicles of the groin or the medial thigh flaps are anastomosed to the muscle branch or the descending branch of the lateral circumflex femoral system, which is the pedicle of the anterior thigh flaps, and the system is joined to a single recipient vessel as a ''bridge'' flap. The main advantages of these mosaic flaps are (1) they offer single recipient vessels, (2) th ey offer a larger extension of the vascular territory of a skin flap, and (3) they offer the possibility of creating custom-made composite f laps such as musculocutaneous and osteocutaneous flaps, and (4) the el evation of the flaps simultaneous with head and neck tumor resection i s possible. Based on cited cases, it is suggested that mosaic flaps ar e suitable to use for reconstruction of massive cervical defects invol ving the cervical skin and the pharyngoesophagus due to recurrent lary ngeal carcinomas.