Pedicled Island Latissimus Dorsi Myocutaneous Flap in Reconstruction of Complex 3D Head & Neck Defects after Tumor Ablation: Refinement of Flap Insetting Techniques in Selected Patients

Abstract

Introduction: Nowadays free tissue transfer is consideredthe golden slandered in reconstruction of major defects inhead and neck regions. Pedicled flaps, however, still haverole in high risk patients. Pedicled island LD myocutaniousflap can provide a massive amount of tissue that can be utilizedand manipulated to reconstruct complex 3D defects withminimal donor site morbidity. Although has been describedlong time ago, the literature is very deficient regarding methodsand techniques to manipulate the flap during transfer andinsetting to fit complex two or three layered 3D reconstruction.The aim of this study is to describe our techniques in analgorithmic pattern within the context of our case series.Methods: In this retrospective study we present 32 patientsunderwent island LD myocutaneous flap for reconstructionof complex head and neck defects (19 patients underwentpartial or total pharyngeal reconstruction ± neck skin, and 13patients underwent lower face ± mandibular reconstructionwith intra oral extension). Average age was 56 years andselection criteria for this technique includes; depleted neckvessels from previous surgery, frozen neck after pre-operativeradiation together with high risk patients. Technical considerationin flap design and in-setting were reported in detailsaccording to the site of reconstruction.Results: We have a single mortality in post-operativeperiod in a medically morbid patient. No whole flap failurein all patients. 2 patients (6.3%) had partial flap loss. Eightpatients (25%) had other complications like fistula, wounddehiscence and donor site problems. Recurrence happened in3 patients. Over all complication rate is 31%. Donor site andwound related complications were treated conservativelyhowever other complications such as flap vascular insult,partial necrosis and delayed fistulas were treated surgically(9.3%).Conclusion: The island subcutaneous LD myocutaniousflap is a very useful tool in reconstruction of complex 3Dhead and neck defects in selected patients. The rate of complicationsare comparable with free tissue transfer whenappropriate techniques are used.