Physical rehabilitation after myocutaneous flaps.

The neck, shoulder, and upper trunk serve as donor sites for commonly used flaps in head and neck reconstruction. In order to prevent permanent functional disabilities, a physical therapy program was organized. The anatomy, physiology, and kinesiology of the shoulder muscles that are commonly used in myocutaneous flaps are reviewed. Their functional deficit and compensation are described. Exercise protocols for each group of muscles were developed. Prevention of postoperative "frozen shoulder" and the avoidance of tension and torsion of the transposed muscle pedicle are important during the immediate post-operative course. Strengthening the agonistic muscles and learning to use them correctly, in order to regain full range of motion, are the main long-term goals.