Composite myocutaneous flaps.

In this past few years myocutaneous (MC) flaps have, to a large extent, replaced other flaps. Because of axial blood supply, they may be used without delay. The MC flaps, useful in head and neck reconstruction, are based on the latissimus dorsi, the pectoralis major, the sternomastoid, and the trapezius. All have discrete independent vasculature that acts as a pedicle for the muscle and skin flap. The sternomastoid MC flaps have limited range and only special areas of usefulness. The latissimus dorsi flap, because it requires special positioning of the patient, has not been as popular as the pectoralis major flap, but both have excellent blood supplies and will reach almost any area of the face and neck to fill defects and cover internal or external surfaces. In addition, the pectoralis major MC flap may be able to carry a segment of rib as a bone graft. The trapezius MC flap does not have as great a range as the others and has a long vascular pedicle that must be carefully handled, but it has the distinct advantage of being able to carry viable bone from the scapular spine to the mandible.