Skip to main content

Advertisement

Log in

Utility and relevance of modified lateral trapezius myocutaneous flap as a locoregional reconstructive option for medium-sized ablative defects in head and neck cancer—our experience

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Lateral trapezius myocutaneous (LTMC) flap has been used less frequently for defects pertaining to head and neck cancer ablative surgical defects. This study is to assess the utility of LTMC flap with a new modification of the flap design.

Methods

This is a retrospective study using LTMC flap with modifications as a reconstructive option for intraoral & extraoral skin defects in head and neck cancer patients following ablative surgery, from August 2014 to October 2019 in a tertiary care hospital. The original technique of LTMC flap was modified for better results and outcomes.

Results

Thirty-five patients underwent lateral trapezius flap reconstruction for ablative defects of oral cavity, laryngopharynx, neck and parotid. Twenty-three patients (65.71%) underwent adjuvant radiation/radiation-chemotherapy while one patient defaulted. Two patients (5.71%) had major flap failure. After the loss of flap in these patients, the operative technique was further modified for better results. However, the disadvantage of using this flap is shoulder disability. Nonetheless in the present study, the disability was reduced after modifying the operating technique by preserving the spinal accessory nerve.

Conclusion

The present study demonstrated minimal functional loss, low morbidity with satisfactory results, thus also reducing treatment cost. Thus, LTMC is a reliable reconstructive option in head and neck cancer patients for medium-sized defects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Elango JK, Gangadharan P, Sumithra S, Kuriakose MA (2006) Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev 7(1):108–112

    PubMed  Google Scholar 

  2. Vigneswaran N, Williams MD (2014) Epidemiological trends in head and neck cancer and aids in diagnosis. Oral Maxillofac Surg Clin North Am 26(2):123–141

    Article  PubMed  PubMed Central  Google Scholar 

  3. El-Marakby HH (2006) The reliability of pectoralis major myocutaneous flap in head and neck reconstruction. J Egypt Natl Canc Inst 18:41–50

    PubMed  Google Scholar 

  4. Demergasso F, Piazza M (1979) Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: A original technique. Am J Surg 138:533

    Article  CAS  PubMed  Google Scholar 

  5. Can A, Orgill DP, Dietmar Ulrich JO, Mureau MA (2014) The myocutaneous trapezius flap revisited: a treatment algorithm for optional surgical outcomes based on 43 flap reconstructions. J Plast Reconstr Aesthet Surg 67(12):1669–1679. https://doi.org/10.1016/j.bjps.2014.07.044(Epub 2014 Aug 6)

    Article  PubMed  Google Scholar 

  6. Guillamondegui OM, Campbell BH (1987) The folded trapezius flap for through-and-through cheek defects. Otolaryngol Head Neck Surg 97(1):24–27

    Article  CAS  PubMed  Google Scholar 

  7. Netterville JL, Panje WR, Maves MD (1987) The trapezius myocutaneous flap Dependability and limitations. Arch Otolaryngol Head Neck Surg. 113(3):271–81

    Article  CAS  PubMed  Google Scholar 

  8. Conley J (1972) Use of composite flaps containing bone for major repairs in the head and neck. Plast Reconstr Surg 49:522–526. https://doi.org/10.1097/00006534-197205000-00008

    Article  CAS  PubMed  Google Scholar 

  9. Baek SM, Biller HF, Krespi YP, Lawson W (1980) The lower trapezius island myocutaneous flap. Ann Plast Surg 5(2):108–114

    Article  CAS  PubMed  Google Scholar 

  10. Panje WR (1980) Myocutaneous trapezius flap. Head Neck Surg. 2(3):206–12

    Article  CAS  PubMed  Google Scholar 

  11. Sugrue CM, Rooney G, Sugrue RM (2017) Trapezius flaps for reconstruction of head and neck defects following oncological resection-a systematic review. J Craniomaxillofac Surg. 45(12):2115–2119. https://doi.org/10.1016/j.jcms.2017.10.001(Epub 2017 Oct 10)

    Article  PubMed  Google Scholar 

  12. Urken ML, Naidu RK, Lawson W, Biller HF (1991) The lower trapezius island musculocutaneous flap revisited Report of 45 cases and a unifying concept of the vascular supply. Arch Otolaryngol Head Neck Surg. 117(5):502–511

    Article  CAS  PubMed  Google Scholar 

  13. Davidson BJ, Kulkarny V, Delacure MD, Shah JP (1993) Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract. Am J Surg 166(4):395–398

    Article  CAS  PubMed  Google Scholar 

  14. McLean T, Kerr SJ, Giddings CEB (2017) Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review. Laryngoscope. 127(9):2074–2080. https://doi.org/10.1002/lary.26573(Epub 2017 Apr14)

    Article  PubMed  Google Scholar 

  15. Terrell JE, Welsh DE, Bradford CR (2000) Pain, quality of life, and spinal accessory nerve status after neck dissection. Laryngoscope 110:620–626

    Article  CAS  PubMed  Google Scholar 

  16. DeLisa JA, Miller RM, Melnick RR, Mikulie MA, Gerber LH (1989) Rehabilitation of the Cancer Patient. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer Principles and Practice of Oncology. ed 2. Philadelphia: JB Lippincott, pp. 2155–88

  17. Short SO, Kaplan JN, Laramore GE, Cummings CW (1984) Shoulder pain and function after neck dissection with or without preservation of the spinal accessory nerve. Am J Surg 148:478–482

    Article  CAS  PubMed  Google Scholar 

  18. Fialka-Moser V, Crevenna R, Korpan M, Quittan M (2003) Cancer rehabilitation particularly with aspects on physical impairments. J Rehabil Med 35:153–162

    Article  PubMed  Google Scholar 

  19. VanRossen ME, Verduijn PV, Mureau MA (2011) Survival of pedicled pectoralis major flap after secondary myectomy of muscle pedicle including transection of thoracoacromial vessels: does the flap remain dependent on its dominant pedicle? J Plast Reconstr Aesthet Surg 64(3):323e8

    Google Scholar 

  20. Hirai H, Omura K, Harada H, Tohara H (2010) Sequential evaluation of swallowing function in patients with unilateral neck dissection. Head Neck 32:896–904

    PubMed  Google Scholar 

  21. VanWilgen CP (2007) Morbidity after neck dissection in cancer. Dutch J Phys Ther 117:116–117

    Google Scholar 

  22. Guru K, Manoor UK, Supe SS (2012) A Comprehensive Review of Head and Neck Cancer Rehabilitation: Physical Therapy Perspectives. Indian J Palliat Care. 18(2):87–97

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bertotti JA (1980 ) Trapezius-musculocutaneous island flap in the repair of major head and neck cancer. Plast Reconstr Surg 65(1):16–21

    Article  CAS  PubMed  Google Scholar 

  24. Tucker HM, Sobol SM, Levine H, Wood B, Katz R (1982) The transverse cervical trapezius myocutaneous island flap. Arch Otolaryngol. 108(3):194–8

    Article  CAS  PubMed  Google Scholar 

  25. Blackwell KE, Azizzadeh B, Ayala C, Rawnsley JD (2002) Octogenarian free flap reconstruction: complications and cost of therapy. Otolaryngol Head Neck Surg 126:301–306

    Article  PubMed  Google Scholar 

  26. Cannady SB, Hatten KM, Bur AM, Brant J, Fischer JP, Newman JG, Chalian AA (2017) Use of free tissue transfer in head and neck cancer surgery and risk of overall and serious complication(s): An American College of Surgeons-National Surgical Quality Improvement Project analysis of free tissue transfer to the head and neck. Head Neck. 39(4):702–707. https://doi.org/10.1002/hed.24669(Epub 2016 Dec 21)

    Article  PubMed  Google Scholar 

  27. Daley BJ, Cecil W, Clarke PC, Cofer JB, Guillamondegui OD (2015) How slow is too slow? Correlation of operative time to complications: an analysis from the Tennessee Surgical Quality Collaborative. J Am Coll Surg 220:550–558. https://doi.org/10.1016/j.jamcollsurg.2014.12.040(Epub 2015 Jan 9)

    Article  PubMed  Google Scholar 

Download references

Funding

Nil.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Abhishek Singh.

Ethics declarations

Conflict of interest

None.

Ethical approval

Yes, Institutional Scientific Committee–RES/SLM/29/2018/62.

Patient consent

Patient consent was taken.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, A., Agarwal, M., Singh, N. et al. Utility and relevance of modified lateral trapezius myocutaneous flap as a locoregional reconstructive option for medium-sized ablative defects in head and neck cancer—our experience. Eur Arch Otorhinolaryngol 277, 2539–2549 (2020). https://doi.org/10.1007/s00405-020-05952-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-05952-6

Keywords

Navigation