[Comparative efficacy of island latissimus dorsi myocutaneous flap versus lower trapezius myocutaneous flap for repair of posterior neck skin and soft tissue defects].

OBJECTIVES: Posterior neck skin and soft tissue defects often result from electrical burns, post-tumor resection, infections, or trauma. The region has complex anatomy, high mobility, and proximity to the cervical spine, major vessels, and critical nerves; thus, reconstruction must balance functional restoration and aesthetic outcomes. The island latissimus dorsi myocutaneous flap, with its reliable blood supply, large harvestable area, and long rotation arc, is widely used for trunk and limb reconstruction and shows particular advantage for large defects in the thoracic, dorsal, and posterior cervical regions. The lower trapezius myocutaneous flap also has a robust vascular base, moderate flap texture, and a relatively flat pedicle, making it especially suitable for repairing longitudinal defects of the occipital and upper posterior neck. However, comparisons between these 2 flaps regarding defect coverage, flap size, donor-site morbidity, and postoperative bulkiness are lacking, and guidance for flap selection based on defect type remains unclear. This study aims to compare the defect coverage area, complications, donor site skin grafting requirements, and postoperative aesthetic and functional outcomes of the 2 flaps, to provide clinical reference for selecting appropriate myocutaneous flaps for different posterior neck defects.

METHODS: We retrospectively analyzed cases from the Department of Burns and Reconstructive Surgery, Xiangya Hospital, Central South University, from January 2010 to December 2024, in which posterior neck defects were repaired using either island latissimus dorsi myocutaneous flaps or lower trapezius myocutaneous flaps. Data collected included demographics, etiology of defects, wound size, flap coverage and dimensions, donor site skin grafting, and surgical complications.

RESULTS: Six cases (aged 19-65 years; 5 males, 1 female) received latissimus dorsi flap reconstruction: 4 electrical burns, 1 dermatofibrosarcoma protuberans, 1 eosinophilic granuloma; defect sizes 16 cm×8 cm to 26 cm×14 cm; flap sizes 28 cm×9 cm to 35 cm×15 cm; 4 required donor site skin grafting. Five patients (aged 27-74 years; 4 males, 1 female) received lower trapezius flap reconstruction: 3 electrical burns, 2 recurrent meningioma excisions affecting occipital/posterior neck skin; defect sizes 12 cm×6 cm to 15 cm×8 cm; flap sizes 15 cm×7 cm to 18 cm×9 cm; 1 required donor site grafting. Apart from 1 elderly patient who developed postoperative hypoxemia, no significant surgical complications were observed. Follow-up ranged from 6 to 15 months (median 9 months); all patients achieved successful healing with preserved neck mobility. Two latissimus dorsi flap patients had slight pedicle bulkiness; no other cases showed notable contour deformities.

CONCLUSIONS: Both island latissimus dorsi and lower trapezius myocutaneous flaps have advantages and limitations in repairing posterior neck skin and soft tissue defects. Latissimus dorsi flaps provide larger coverage but pedicles may appear bulky, whereas lower trapezius flaps offer smaller coverage but are suitable for longitudinal occipital and upper posterior neck defects. Selecting an appropriate flap based on defect characteristics generally yields satisfactory functional and aesthetic outcomes.