Use of Extended Vertical Lower Trapezius Island Myocutaneous Flaps to Cover Exposed Reconstructive Plates

Abstract

Plate exposure is the most common complication after reconstruction of oncologic resection using a titanium plate. The outcomes of covering exposed reconstructive plates with extended vertical lower trapezius island myocutaneous flaps (TIMFs) were evaluated. Twelve instances of exposure of reconstructive plates occurred in patients after segmental mandibulectomy to treat cancer of the oral cavity and oropharynx. The plates were covered with extended vertical lower TIMFs. The site of the primary tumor was the gingiva or mandible in 5 cases, the buccal mucosa in 3, the floor of the mouth in 2, and the base of the tongue in 2. The types of bone defect were hemimandibular in 1 case, central in 2, and lateral in 9. Intraoral, extraoral, and intra- and extraoral exposures occurred in 1, 7, and 4 instances, respectively. Intraorally and extraorally exposed plates were re-covered with skin paddles measuring 6 × 7 to 6 × 23 cm (average, 6.0 × 13.5 cm). Four folded extended vertical lower TIMFs were constructed to cover plates exhibiting intra- and extraoral exposure. All flaps survived. Patients were followed for 12 to 36 months (median duration, 22.8 months). One patient (8.3%) exhibited external plate exposure at 20 months. Nine patients (75.0%) were alive with no evidence of disease at 12 to 36 months, and 2 (16.7%) were alive with disease at 20 to 28 months. One patient (8.3%) died of local recurrence at 23 months. The use of extended vertical lower TIMFs to cover intraorally, extraorally, or intra- and extraorally exposed plates is reliable.