Myocutaneous Flaps in Reconstruction of Head and Neck after Cancer Surgery

Abstract

Radical cancer surgery produces massive defects in the head and neck which require multilayered tissues for coverage. Historically, large defects in head and neck underwent staged reconstruction. Recently, immediate reconstruction involved the management of these defects. The primary application of myocutaneous flaps in head and neck reconstruction include provision of tissue bulk, coverage of important structures; provision of skin for intraoral lining and coverage; and provision of skin for skull, facial and neck defects. Pedicled myocutaneous flaps that used in head and neck reconstruction are; pectoralis major, latissimus dorsi, trapezius, sternocleidomastoid and platysma. Pectoralis major is a type V, large and broad muscle used in external resurfacing of the skin of the face and neck; intraoral and pharyngeal lining; carrying vascularised rib and skin in mandibular reconstruction. Latissimus dorsi is a type V muscle; historically it was used in head and neck reconstruction for large defects or when previous radiation or surgery precluded the use of other flap. Now, is used in intraoral, pharyngeal, mandible, posterior neck, shoulder, anterior neck lower face and occipital reconstruction. Trapezius, a type II muscle, located superiorly and has wide anterior arc of rotation. Modifications in design have enabled the trapezius to be used as distinctly different upper and lower myocutaneous flaps. It is used in lower facial reconstruction, lateral upper face and scalp repair; anterior and posterior neck reconstruction; orbital reconstruction; and pharyngoesophageal reconstruction. Sternocleidomastoid is a type II muscle, used in intraoral and pharyngeal reconstruction. Other uses are augmentation of soft tissues defects of the upper neck and jaw, protective coverage of major vessels, and closure of pharyngeocutaneous fistule. It is the least reliable myocutaneous flap. Platysma is a type II, thin, broad, sheet like and used for reconstruction of full thickness defect of the cheek, intraoral, lip, lower midface, and anterior neck. Head and neck cancer patients are frequently treated by chemotherapy, which often associated with poor general and local condition that impair the healing process and reduce tolerance of surgical stress and thus, many head and neck cancer patients are ineligible for free flap reconstruction.