T. Safak et al., HEAD AND NECK RECONSTRUCTION WITH THE LATISSIMUS-DORSI MUSCULOCUTANEOUS PEDICLED FLAP - FUNCTIONAL PRESERVATION OF THE MUSCLE BY STAGED TRANSFER, Annals of plastic surgery, 41(2), 1998, pp. 156-161
The reconstruction of soft-tissue defects in the head and neck region
with the latissimus dorsi musculocutaneous pedicled flap is traditiona
lly carried out with dissection of a transaxillary subcutaneous tunnel
, which may result in compression of the vascular pedicle in the tunne
l, a contour deformity of the neck, or morbidity to the tissues in the
axilla and the neck (such as hematoma and seroma). Furthermore, the f
laps are often bulky and require secondary defatting. Loss of the musc
le causes contour deformity in the back, and its functional loss may b
e a concern for the patient. To overcome such drawbacks of the traditi
onal use of the flap, we devised a technique of regional transfer of t
he latissimus dorsi musculocutaneous pedicled island flap to the head
and neck region over a pectoral skin bridge rather than utilizing a tr
ansaxillary subcutaneous tunnel. This is a two-stage procedure. During
the first stage the musculocutaneous flap is transposed in an extracu
taneous route to the recipient site. Following a 3-week neovasculariza
tion period, the second stage is performed, during which the muscle is
detached from its overlying skin island and replaced in situ. This te
chnique was utilized successfully in 5 patients for reconstruction of
various head and neck defects with no complications. We conclude that
this staged technique of latissimus dorsi musculocutaneous flap transf
er to the head and neck region enables functional preservation of the
muscle and overcomes many of the complications of the traditional meth
od of utilizing a transaxillary subcutaneous tunnel.