Deltopectoral Flap Research Articles

Deltopectoral Flap in Head and Neck Reconstruction.

Background and Objectives: The deltopectoral (DP) flap represents a reconstructive option for the head and neck. It is a fasciocutaneous flap raised from the anterior chest wall below the clavicle. Its role partially declined with the arise of free flaps. However, it still remains a valid option in patients that could not undergo a reconstruction with free flaps. The aim of this retrospective study was to evaluate the role of the DP flap in head and neck reconstruction, with a focus on surgical outcomes and complications. Materials and Methods: Thirty-one patients who underwent head and neck reconstruction with DP flap were included in the study. The delayed technique was not used in any procedure to harvest the flap beyond the deltopectoral groove. The patients' characteristics, the recipient site, the closure of the donor site, and the flap-related complications were recorded. Results: The median time to autonomization of DP flap was 23 days. Postoperative complications were observed in 10 subjects (32.3%). A partial necrosis was seen in five patients (16.1%), while a complete necrosis developed only in one case (3.2%). The diabetes mellitus was the only parameter associated with postoperative complications. In particular, the percentage of necrosis in subjects with or without diabetes was 66.7% and 8.0%, respectively. Conclusions: The DP has a wide range of applications in head and neck reconstruction, and a low complication rate can be observed. The delayed technique does not necessarily need to be applied, and the flap can be extended beyond the deltopectoral groove when necessary. However, patients with diabetes mellitus have a higher risk of postoperative necrosis of the distal portion of the flap.

The internal mammary artery perforator flap in pharyngoesophageal, cervical tracheal, and cutaneous neck reconstruction.

The internal mammary artery perforator (IMAP) flap is an evolution of the deltopectoral flap that is harvested based upon a single perforator from the internal mammary artery. Its favorable characteristics include pliability as a fasciocutaneous flap, ease of harvest, and minimal donor site morbidity. In this paper, we report our harvest technique and the versatility of the IMAP flap for pharyngoesophageal, cervical tracheal, and cutaneous neck defects. We seek to highlight the IMAP as a useful regional reconstructive option in both the primary and salvage reconstructive setting. As such, this flap is an important option in the head and neck reconstructive surgeon's armamentarium.

Single Stage Deltopectoral Flap for Reconstruction of the Soft Tissue Defects of Neck.

The online version contains supplementary material available at 10.1007/s12070-024-04641-8.

Deltopectoral flap reconstruction with primary repair in a patient with cutaneous neck metastasis of thyroid cancer; a case report

Background: Deltopectoral flap is the most commonly used fasciocutaneous, transpositional flap, which relies on the blood supply of intercostal perforators of the internal thoracic artery, usually requiring skin grafting to the donor site. Cutaneous metastasis of papillary thyroid carcinoma is rare. Here we report a case of deltopectoral flap reconstructive surgery in a patient with cutaneous neck metastasis of papillary thyroid carcinoma.
 Case Presentation: A 65 year old male who underwent a total thyroidectomy in 2013 for papillary thyroid carcinoma, presented with a skin neck metastasis for six months. It was an approximately 8cm diameter hemispherical lump over the left anterior root of the neck extending to the upper chest. Biopsy confirmed the diagnosis of cutaneous metastasis of thyroid papillary carcinoma. Wide local excision of the lump and deltopectoral flap reconstruction was performed without requiring skin grafting for the donor site.
 Conclusion: Effectiveness of use of deltopectoral flap as a reconstructive option for radical thyroid cancer surgeries which result in skin defect. 
 
 Keywords: Deltopectoral flap, Reconstruction, Papillary thyroid carcinoma, Cutaneous metastasis 

Reconstruction of Hemifacial Congenital Giant Nevus with Pre-expanded Scalp Flaps and Deltopectoral Skin Flaps.

The hemifacial congenital giant nevus impacts both physical and mental health of the patients. Excision is typically the most suitable option in these situations, but reconstructing the subsequent surgical defects is always a serious challenge. Between February 2012 and January 2021, a retrospective review of 4 patients who suffered from hemifacial congenital giant nevus was conducted, and they were treated by pre-expanded scalp flap and deltopectoral flap simultaneously. All patients receive tissue expansion, nevus resection, expanded skin flap transfer, and pedicle division. Four patients with hemifacial congenital giant nevi were successfully treated with no major complications. One patient with a transferred deltopectoral flap experienced distal necrosis of the flap, and healed after dressing changes. No recurrence of the nevus was found during the follow-up period, and the transferred skin flaps match well with facial skin in contour and color. This modified pre-expanded scalp flap combined with a deltopectoral flap provides an easy and reliable way for hemifacial reconstruction in patients with a congenital giant nevus.

Application of Preexpanded Free Flaps Based on Thoracic Branch of Supraclavicular Artery for Facial Scar Treatment.

As an exposure region, the face is susceptible to burn injuries, which often lead to physical and psychological problems. For facial scar reconstruction, the subclavicular region has the advantages of matched color, similar texture, and thin and pliable tissue supply. The island or pedicled subclavicular flap, which is nourished by the thoracic branch of supraclavicular artery (TBSA) had been reported to cover cervical facial defects and achieved good outcomes. However, the main restriction is the limitation of the pedicle length. Therefore, the authors applied preexpanded TBSA free flap transplantation for treatments of upper and contralateral facial scars to overcome the pedicle limitation. Three patients were treated with preexpanded TBSA flaps to repair the facial defects after scar resections. Two of them were combined with forearm or deltopectoral flaps according to different purposes. The patients were followed up for 2 to 7 years. The clinical data and surgical techniques were recorded and analyzed. The scars were scored by Vancouver Scar Scale. Two of the TBSA flaps survived well without complication. Partial flap necrosis in the distal end was healed by dressing changes, and mild contracture in the left medial canthus was corrected by Z plasty in case 1. The scars around transferred flaps and donor sites were scored 3 to 4 by Vancouver Scar Scale. The patients were satisfied with the outcomes. All the donor sites were closed primarily. A preexpanded TBSA-free flap could overcome the restriction of pedicle length for reconstruction procedures. The method is a feasible alternative of thoracic flaps to repair facial defects beyond pedicle limitation.

Management of an Unusual Avulsion Trauma of Total Esophagus During Upper Gastrointestinal Endoscopy.

An esophageal defect usually resulted from surgical ablation of tumors or corrosive injury. Staged reconstructions are required usually in extensive defects. This study aimed to present a rare iatrogenic complication of total esophageal avulsion injury during upper gastrointestinal endoscopic treatment and to perform staged reconstructions to create a neoesophagus. In the presented case, staged reconstructions with a tubed deltopectoral flap and a supercharged colon interposition flap were performed to reconstruct the hypopharynx and esophagus. However, recurrent choking occurred because of the extent of injury involving the epiglottis. A tubed free radial forearm flap connected to the lower buccogingival sulcus was used to create a new route for food passage. The patient resumed oral intake after rehabilitation. The avulsion injury of the total esophagus is rare and devastating. Staged reconstructions with a tubed deltopectoral flap, a supercharged colon interposition flap, and a tubed free radial forearm flap would be a safe and reliable method.

Combined pectoralis major and deltopectoral flap for reconstruction in head and neck cancer: Revisiting the historic flap

Introduction Deltopectoral flap was discovered in early 90’s and used for nasal and pharyngeal reconstructions, since then its use has diminished over the years. We have tried to use this historic flap with the robust pectoralis major flap to reconstruct large head and neck defects. Though the ideal flap for such defects would be a free flap, in developing nations due to resource intense settings free flap is not always feasible. Our aim is to review combined deltopectoral and pectoralis major flap for large head and neck reconstructions. Materials and Methods A retrospective study of 30 patients was done in our institute. Patients included in the study were resectable head and neck cancers with extensive skin involvement. A combined deltopectoral and pectoralis major flap was used to reconstruct the defect. Conclusion A combined use of deltopectoral and pectoralis major flaps can be an effective alternative to free flaps in developing nations due to lack of resources and large volume of cases.

Clinical presentation and management of parotid gland tumors – A retrospective study in Northwestern Nigeria

Background: Parotid gland tumors are the most common major salivary gland tumors occurring in humans. Aim: This study aimed to evaluate the pattern of clinical presentation and management of parotid gland tumors in Northwestern Nigeria. Materials and Methods: In this retrospective study sociodemographics, nature of the lesion, fine-needle aspiration cytology result, surgical procedure, and complications of patients with parotid gland tumors were recorded and analyzed using SPSS version 25. Results: There were 31 (45.6%) males and 37 (54.4%) females in the age range of 17–72 years with a mean ± standard deviation of 49.03 ± 15.61 years. Benign tumors constitute the majority 50 (73.5%), with pleomorphic adenoma being the most common 46 (67.6%), whereas malignant tumors were 18 (26.5%), with adenoid cystic carcinoma being the most common 6 (8.8%). Superficial parotidectomy was the highest surgical procedure performed in 42 (70.6%) patients. Selective neck dissection was done in 5 (27.8%) cases and soft tissue reconstruction with deltopectoral flaps in 3 (16.7%) of the malignant cases. Transient facial nerve paralysis was seen in 14 (29.2%) and 8 (47.1%) of patients who had superficial and total parotidectomies, respectively. Permanent facial nerve paralysis was seen in all 5 (27.8%) patients who had radical parotidectomy. Conclusion: Pleomorphic adenoma was the most common parotid gland tumor, and superficial parotidectomy was the major surgical procedure performed. Facial nerve paralysis is an inevitable complication but can be minimized with meticulous surgical maneuver.

Regional pedicled flap salvage options for large head and neck defects: The old, the new, and the forgotten.

The objective of this article is to review options for regional pedicled reconstruction for large head and neck defects in a salvage setting. Relevant regional pedicled flaps were identified and reviewed. Expert opinion and supporting literature were used to summarize and describe the available options. Specific regional pedicled flap options are presented including the pectoralis major flap, deltopectoral flap, supraclavicular flap, submental flap, latissimus flap, and trapezius flap. Regional pedicled flaps are useful options in a salvage setting even for large defects and should be in the armamentarium of any reconstructive head and neck surgeon. Each flap option carries specific characteristics and considerations.

10-Year Experience with the Modified Pectoralis Major Flap: The Use of the Deltopectoral Flap to Reduce Skin Tension.

Purpose: Pectoralis major myocutaneous flap has been the work horse flap for head and neck reconstruction. However, due to the bulky nature of the pedicle it is not uncommon to struggle to achieve tension free closure of the neck skin incision. This case series presents a modified pectoralis major flap technique to overcome the difficulty of tight closure or the need to graft the residual cutaneous defect. Method: This 10-year study includes 73 patients who underwent modified pectoralis major flap reconstruction for complex laryngo-pharyngeal defects following resection of tumours involving larynx, hypopharynx oropharynx and cervical oesophagus. The modified technique involves accommodating a deltopectoral fasciocutaneous flap which rotates over the pedicle to insert into the neck incision providing extra tissue to achieve a tension free closure. Results: 73 patients underwent the procedure, 80% were male. Mean age of patients was 62.8years. Larynx was the most common site and the average size of the tumour was 34.8mm. 13 patients developed minor complications such as wound dehiscence out of which 10 were managed conservatively, 3 patients required additional reconstructive procedures. 13 patients developed pharyngocutaneous fistula and 6 developed Neopharyngeal stenosis. 51 patients achieved good swallowing and 55 developed intelligible speech following recovery. Conclusion: We recommend the use of this technique as an effective method to achieve tension free neck incision closure and improved cosmetic results especially in centres which do not have free flap facility readily available.

Use of the deltopectoral flap for reconstruction of a complex cervical defect: case report

We present a case report of a patient who underwent complex reconstruction of the pharynx and esophagus with microsurgical anterolateral thigh flap and deltopectoral flap for reconstruction of an extensive defect in the cervical region. We will discuss a little about the deltopectoral flap, which was the first choice for the reconstruction of cervical defects in the past, but nowadays it is still an important tool for head and neck defect reconstruction.

Two Pre-Expanded Free Flaps Used for Auricular Reconstruction and Ipsilateral Facial Scar Release

Auricular reconstruction is a great challenge for surgeons to achieve good aesthetic outcomes when adjacent tissues were burned. Compared with pedicle flap therapies, there are some advantages of pre-expanded free flaps for ear rebuilding, such as thinner layer tissues for aesthetic requirements of delicate auricular structures and less donor site deformity. In this study, the authors introduced 6 sequential surgical procedures for total auricular reconstruction with severe ipsilateral facial scar. Pre-expanded deltopectoral flap was used to release periauricular contracture and repair facial scar. The injured ear was restored by expanded forearm flap including autologous cartilage framework. The surgical procedures were lasted more than 2 years. An 8 and half year's follow-up was performed from November 2012 to April 2021. The clinical data and surgical techniques were recorded and analyzed. The patient was satisfied with the aesthetic outcomes of the new ear. The skin texture and color of the grafts were approximately matched to the recipient sites. Facial expression was not affected severely. Sensations of the transferred flap and new ear had partially recovered. The donor sites were recovered without severe complication. The pre-expanded free forearm flap is a feasible method for total ear reconstruction when local flap therapies could not be applied. Repair of ipsilateral facial scar is beneficial for auricular procedures.

TRANSPLANTATION METHODS FOR CORRECTION OF MANDIBULAR SOFT TISSUE DEFECTS

Goal: This paper aims to identify optimal transplantation methods for correcting soft tissue defects of the face and mandible based on our medical records and study of up-to-date research literature. Materials and methods: The analysis of standard transplantation procedures was carried out, as well as research of patients charts with extensive defects of the lower jaw at the department of maxillofacial surgery of a Moscow oncological hospital. There was a comparative analysis of the following most popular methods of correction of soft tissue defects of the face and lower jaw: Trapezoidal flap Filatov and H.D. Gillies stem grafting Deltopectoral flap Thoracodorsal flap Temporal parietal flap - Lexer and Esser method Results: Plastic surgery with complex grafts on the neurovascular pedicle is used in the surgical treatment of injuries and diseases of the mandible, which are accompanied by deep defects in the soft tissues of the face and bones of the mandible. The most optimal methods for restoring the anatomical integrity of the mandible, which is necessary for adaptation of the patient in society, and restoration of speech and chewing functions have been identified. Conclusion: Nowadays, the most common and effective methods in the world of eliminating mandibular defects by transplantation are considered to be Lexer’s method (temporal parietal flap), transplantation of the delto-pectoral flap, as well as thoracodorsal on feeding pedicle. The clinical researches conducted in the Moscow Oncological Hospital confirmed generally successful outcomes without complications.

Analysis of various defects and reconstructive methods after invasive thyroid carcinoma resection

ObjectiveThe thyroid gland adjoins the trachea, pharynx, esophagus, carotid artery and cervical skin. Most thyroid carcinomas have been treated at lower stages; however, in some cases the carcinomas have invaded the surrounding organs. After resecting invasive thyroid carcinomas, the defects vary depending on the invasion area and organs affected; subsequent reconstructive methods vary depending on the size of defect and its components. This study analysed the pattern of defects and the reconstructive methods used following invasive thyroid carcinoma resection. MethodsFrom April 2011 to March 2021, 665 patients in Saitama Cancer Center (Saitama, Japan) were diagnosed with thyroid carcinoma and subsequently underwent thyroidectomies. In the 25 patients (3.8%), the thyroid carcinoma invaded surrounding organs and any reconstructive surgery—including end-to-end tracheal anastomosis and simple pharynx closure—was performed after thyroid carcinoma resection. The patients’ records were retrospectively reviewed, and the defects and subsequent reconstructive methods were analysed. ResultsWhen our new classification system was applied to the defects, the number of cases for each type was totaled: Tr0: 1; Tr1a: 3; Tr2b: 5; Tr3a: 1; La-Tr3b+PE2: 7; La-Tr3b+PE2+S2: 1; PE1: 1; PE1+S1: 2; S1: 2; S2: 2. For Tr0, a tracheal fenestration was performed after the tumor resection and the fenestration was closed with a hinge flap. For Tr1a defect, a tracheal fenestration was performed with cervical skin after the tumor resection and the tracheal fenestration was closed with a deltopectoral flap or pectralis major musculocutaneous flap. In one recent patient, the tracheal fenestration was reconstructed using free forearm flap and cervical skin, and the fenestration was closed with a hinge flap. For Tr2b defect, free forearm flap and costal cartilage graft reconstruction was performed after the tumor resection and the fenestration was closed with a hinge flap. For Tr3a defect, end-to-end anastomosis was performed in one patient. For La-Tr3b+PE2 defect, total pharyngolaryngectomy with free jejunal flap reconstruction was performed. For PE1 defect, a simple closure was performed in one patient and a PMMC muscle flap was used for covering the suture line in two patients. For S1 and S2 defect, PMMC flap or DP flap was used. ConclusionOur analysis of defects and reconstructive methods defines the complex defect patterns occurring after invasive thyroid carcinoma resection, describes the patterns of subsequent reconstructive methods.

HEAD AND NECK RECONSTRUCTION WITH MAJOR REGIONAL FLAPS; WHAT THE COVID-19 PANDEMIC TAUGHT US

Objectives The aim of this study was to record the patients with advanced head and neck cancer who received a major regional flap for reconstruction in the COVID-19 pandemic period. Materials and Methods The surgical registry of a single centre was retrospectively searched for identification of patients who met the inclusion criteria of receiving a major regional flap for head and neck reconstruction, after resection of a locally advanced tumour, during the COVID-19 pandemic. The period recorded on this study as March 2020 to February 2021. All data available were recorded (tumour type, staging, operation, reconstruction) as well as post-operative follow up until up to date. Results 10 patients met the inclusion criteria. Mean age was 71.9 years old. 6 patients were newly diagnosed patients, whereas 4 were patients with recurrence. As far as staging is concerned, all had stage IV cancers, whereas 6 patients had T4 tumours, 2 T3 and 2 Tx. The latter 2 concern a patient with an occult neck mass of unknown origin and a patient with parotid adenocarcinoma. 4 patients were reconstructed with pectoralis major flap, 4 patients with cervicothoracic flaps, 1 with cervicofacial flap and 1 with deltopectoral flap. All immediate post-operative periods were uneventful but one, who presented a localized hematoma which required drainage. 5 patients appeared with a recurrence in the follow-up period of the first year and did not survive. The rest are surviving disease free with a mean follow-up period of 1.5 years. Conclusion Major regional flaps remain a valid alternative for head and neck reconstruction in patients with advanced head and neck cancer. The COVID-19 pandemic reduced the available human and technical resources for other types of flap reconstructions, forcing the use of regional flaps as the treatment of choice for advanced patients.

SALVAGE TONGUE FLAP IN A CURIOUS CASE OF PECTORAL GAP PHENOMENON

Pectoralis Major myocutaneous (PMMC) flap is the workhorse for reconstruction in composite resection of oral cavity cases where free flaps are not feasible or not indicated. Due to the ease of harvesting it and shorter learning curve, it is done in most of the cases. But when there are any intraoperative complications like shearing of the flap or if there are any anamolies in the muscle, the surgeons have options for reconstruction like deltopectoral flap, forehead flap, nasolabial flap, latissimus dorsi flap and so on with their own advantages and disadvantages. Tongue flap is an option to be considered albeit occurrence of some restriction in the tongue movement and articulation difficulty in post operative life. Here we discuss a case of absent medial part of pectoralis major muscle for which we did a salvage tongue flap.

Deltopectoral Flap Reconstruction of the Posterior Pharyngeal Wall: A Single Stage Pedicle Flap Alternative Solution to the Free Flap Reconstruction of Circumferential Laryngopharyngeal Defects.

The first option for reconstruction of a circumferential pharyngeal defect following extensive pharyngo-laryngectomy is free tissue transfer. Despite that, pedicled flaps can be used when microsurgical expertise is not available or if other patient related or region related issues deem free tissue transfer unfavourable. The aim of this study was to review the operative feasibility and functional outcomes following dual flap reconstruction of circumferential pharyngeal defects.This was a retrospective study of all patients (n = 8) who underwent either primary (n = 5) or salvage (n = 3) circumferential laryngopharyngectomy + /– cervical oesophagectomy, followed by dual flap reconstruction, with a deltopectoral flap to reconstruct the posterior wall from 2005 to 2020. The main outcome measures were operative complications, hospital stay and functional outcomes (speech and swallowing). The operation was feasible in all patients, with dual flap reconstruction using a deltopectoral flap, combined with a pectoralis major flap (n = 5) or a supraclavicular flap (n = 3). All patients developed a small, lateralised, self-healing fistula at the site of the deltopectoral flap 3-point junction. This did not require any intervention, or impact on adjuvant treatment. Functional outcomes were favourable, with all patients achieving oral diet. One patient required gastrostomy diet supplementation, and one patient required stricture dilatation. Of the patients able to receive a speech valve (n = 4), all achieved intelligible speech. Dual flap reconstruction of circumferential pharyngeal defects represents a feasible alternative option for a complex reconstructive problem. The predictable operative recovery and favourable functional outcomes indicate that the use of both a deltopectoral flap and a second flap is a robust reconstructive solution.

A case of electric injury with exposed neck vessels and scapula treated with flaps

In modern times, the use of electricity has increased many times and so has the incidence of high-voltage electrical injuries. The incidence of high-voltage electrical injuries is much higher in developing countries when compared to developed countries, lack of proper transmission systems being the cause. Electric burn injuries lead to debilitating morbidity to the affected patients and are often deadly. In such cases with exposed vessels in the neck, major flaps such as the deltopectoral flap or forehead flap or free flaps increase the hospital stay or two-staged procedures and hence increase the morbidity of such patients. Here, we present a case of a young male patient who sustained an electric injury to his foot, neck, and shoulder, which was managed with the platysma flap and parascapular flap with no donor site morbidity.

Pedicled Forehead Flap for Reconstruction of Cheek Defect: A Novel Surgical Case Report

Oral cancers are considered slow killer disease. Every year 3,00,000 cases are diagnosed worldwide. Public awareness has been a great challenge to educate people to avoid harmful oral habits to prevent oral cancer. People are not aware about life threatening complications such as death due to oral cancer. Oral cancer is the eighth most common malignancy in India and third most common malignancy in South East Asia. Buccal mucosa carcinoma spreads rapidly and invades deeply to underlying tissues and has high recurrence rate. Surgical resection is more challenging if the tumour invade adjacent anatomical structures and reconstruction should be planned according to extent of tumour resection. Regional flaps are used for oral cavity after tumour resection such as radial forearm flap, deltopectoral flap, pectoralis major flap, latissimus dorsi flap, transverse rectus abdominis myocutaneous flap, trapezius flap. In this case report folded forehead pedicle flap was used to provide both inner and outer linings of the cheek defect following buccal mucosa tumour resection.