[Clinical application of rhombotrapezious island musculocutaneous flap for skull base and/or craniomaxillary operation with malignant tumor].

Regional pedicled musculocutaneous flaps are the mainstay of the head and neck reconstruction. They provide a rapid, highly reliable and single-staged technique that is applicable in most cases. The rhombotrapezious island musculocutaneous flap is valuable in the base and craniomaxilloface reconstruction. In this study we updated our experience with the rhombotrapezious island musculocutaneous flap (RTIMF) in 6 cases from 1989 to 1993. Dissections were performed on 9 cadavers, 4 preserved and 5 fresh, yielding 18 pairs or dorsal scapular and transverse cervical artery for evaluation. In the five fresh cadavers, the arteries were selectively cannulated and injected with colored latex. 67% with dorsal scapular and transverse cervical artery commonly arose from the thyro-cervical trunk. 33% with the dorsal scapular artery directly arose from the second part of the subclavian artery. In the period of 1989-1993, 6 rhombotrapezious island musculocutaneous flaps with vascularized pedicle were used for immediate repair in the skull base or craniomaxillary cancer operations. There was no complication of the flaps. Donor site complications were relatively minor. The disturbance in shoulder function was well tolerated. We advocated the incorporation of both the greater and lesser rhomboid muscle to form the compound rhombotrapezious flaps to enhance the vascular supply to the overlying skin. The major advantage of the RTIMF are that it provides a long paddle of thin pliant, hairless skin and muscle that can be rotated as far as the craniomaxilloface and scalp in a single stage. It offers the longest arc of rotation and thus the greatest versatility for the skull base or craniomaxillary reconstruction.