J Reconstr Microsurg 2014; 30(05): 305-312
DOI: 10.1055/s-0033-1361841
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Role of Free Tissue Transfer in Posterior Neck Reconstruction

Ravit Yanko-Arzi
1   Department of Reconstructive and Aesthetic Surgery, Tel Aviv Sourasky Medical Center, Israel
,
Eyal Gur
1   Department of Reconstructive and Aesthetic Surgery, Tel Aviv Sourasky Medical Center, Israel
,
Alexander Margulis
2   Department of Plastic Surgery, Hadassah Medical Center, Hadassah Medical Campus–Ein Kerem, Jerusalem, Israel
,
Jacob Bickels
3   The National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Israel
,
Shlomo Dadia
3   The National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Israel
,
Yair Gortzak
3   The National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center, Israel
,
Arik Zaretski
1   Department of Reconstructive and Aesthetic Surgery, Tel Aviv Sourasky Medical Center, Israel
› Institutsangaben
Weitere Informationen

Publikationsverlauf

14. September 2013

14. September 2013

Publikationsdatum:
07. Januar 2014 (online)

Abstract

Reconstruction of the posterior neck is one of the rarer procedures performed by plastic surgeons; we used free flaps for the closure of defects in this area in six cases over the past 4 years. Six patients were located requiring posterior neck reconstruction between the years 2007 and 2013. Five of these patients required reconstruction due to oncologic resections, while one underwent serial removal of a giant congenital nevus. Five of these reconstructions involved the use of a free anterolateral thigh/vastus lateralis flap, and the sixth received a pre-expanded deep inferior epigastric perforator flap. Satisfactory dorsal neck reconstruction was achieved with the free flap approach: it produced excellent healing, contour and coverage of hardware. There was only one early minor complication, allowing early return to daily activities and continuation of planned oncologic treatment. Free flap reconstruction of the posterior neck area is a safe and relatively rapidly performed procedure that yields good results both functionally and aesthetically. In this article, we review the literature on the options available for reconstruction of the posterior neck, describe our surgical experience in such cases, and suggest an algorithm to guide in choosing the optimal approach for a given patient.

 
  • References

  • 1 Margulis A, Adler N, Eyal G. Expanded deep inferior epigastric artery perforator flap for reconstruction of the posterior neck and the upper back in a child with giant congenital melanocytic nevus. J Plast Reconstr Aesthet Surg 2010; 63: e703-705
  • 2 Masquelet AC, Gilbert A. An Atlas of Flaps of the Musculoskeletal System. London: Martin Dunitz; 2001
  • 3 Tan KC, Tan BK. Extended lower trapezius island myocutaneous flap: a fasciomyocutaneous flap based on the dorsal scapular artery. Plast Reconstr Surg 2000; 105: 1758-1763
  • 4 Haas F, Weiglein A, Schwarzl F, Scharnagl E. 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: 1580-1590
  • 5 Stillaert FB, Van Landuyt K. Stable coverage of a cervico-thoracic defect with an extended lower trapezius myocutaneous flap. J Plast Reconstr Aesthet Surg 2009; 62: e101-e102
  • 6 Angrigiani C, Grilli D, Karanas YL, Longaker MT, Sharma S. The dorsal scapular island flap: an alternative for head, neck, and chest reconstruction. Plast Reconstr Surg 2003; 111: 67-78
  • 7 Horch RE, Stark GB. The contralateral bilobed trapezius myocutaneous flap for closure of large defects of the dorsal neck permitting primary donor site closure. Head Neck 2000; 22: 513-519
  • 8 Bravo FG, Schwarze HP. Free-style local perforator flaps: concept and classification system. J Plast Reconstr Aesthet Surg 2009; 62: 602-608 ; discussion 609
  • 9 Lecours C, Saint-Cyr M, Wong C , et al. Freestyle pedicle perforator flaps: clinical results and vascular anatomy. Plast Reconstr Surg 2010; 126: 1589-1603
  • 10 Taylor GI. The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg 2003; 30: 331-342
  • 11 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124: 1529-1544
  • 12 Gopinath KS, Chandrashekar M, Kumar MV, Bhargava A. The scapular fasciocutaneous flap: a new flap for reconstruction of the posterior neck. Br J Plast Surg 1993; 46: 508-510
  • 13 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004; 26: 759-769
  • 14 Lin YT, Lin CH, Wei FC. More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap. J Plast Reconstr Aesthet Surg 2006; 59: 622-627
  • 15 Bauer BS, Margulis A. The expanded transposition flap: shifting paradigms based on experience gained from two decades of pediatric tissue expansion. Plast Reconstr Surg 2004; 114: 98-106
  • 16 Laitung JK, Batchelor AG. Successful preexpansion of a free scapular flap. Ann Plast Surg 1990; 25: 205-207
  • 17 Nazerani S, Motamedi MH, Keramati MR, Nazerani T. Upper extremity resurfacing via an expanded latissimus dorsi musculocutaneus flap for large circumferential defects: the “spiral” reconstruction technique. Strategies Trauma Limb Reconstr 2010; 5: 115-120
  • 18 Tsai FC. A new method: perforator-based tissue expansion for a preexpanded free cutaneous perforator flap. Burns 2003; 29: 845-848
  • 19 Kostakoğlu N, Keçik A. Deep inferior epigastric artery (DIEA) skin flap: clinical experience of 15 cases. Br J Plast Surg 1998; 51: 25-31
  • 20 Shang Z, Zhao Y, Ding H, Liu B, Cao D, Wang B. Repair of hand scars by a dilated deep inferior epigastric artery perforator flap. J Plast Surg Hand Surg 2011; 45: 102-108
  • 21 Acarturk TO, Glaser DP, Newton ED. Reconstruction of difficult wounds with tissue-expanded free flaps. Ann Plast Surg 2004; 52: 493-499