Bilateral Pre-expanded Angel-Wing Lower Trapezius Myocutaneous Flaps for Extensive Cervicothoracic Defect Reconstruction.

BACKGROUND

Lower trapezius myocutaneous flap (LTMF) is widely used for reconstructing head and neck defects. However, a single LTMF, even after pre-transfer tissue expansion, is often insufficient to cover defects involving the bilateral neck and chest wall. This study presents our experience with the use of bilateral pre-expanded LTMFs for repairing extensive cervicothoracic defects.

METHODS

A retrospective study was conducted of patients who underwent bilateral pre-expanded LTMF reconstruction between March 2013 and August 2024. Patient demographics, defect features, flap characteristics, and surgical outcome were recorded to assess the efficacy and safety of the procedure.

RESULTS

Ten patients underwent reconstruction of bilateral pre-expanded LTMF reconstruction. The median age was 18 years (range, 5-41 years). The median defect size was 222.5 cm 2 on the left (range, 85-390 cm 2 ) and 246 cm 2 on the right (range, 80-490 cm 2 ). Tissue expansion lasted 3.5-9.5 months. The median flap size was 420 cm 2 on the left (range, 150-660 cm 2 ) and 477 cm 2 on the right (range, 260-645 cm 2 ). Fourteen flaps were transferred through subcutaneous tunnels, while 6 were transferred through an open wound between donor and recipient sites in a propeller fashion. The donor sites were closed primarily in all patients. Complete flap survival was achieved in 9 patients, while 1 patient experienced flap tip necrosis.

CONCLUSIONS

Bilateral pre-expanded LTMFs represent a reliable reconstructive option for cervicothoracic defects, providing satisfactory functional and aesthetic outcomes.