Operative treatment of head and neck cancers can result in impairment of swallowing, speech, respiration and appearance. Alongside control of the disease, rehabilitation is an essential goal of treatment. Reconstruction, often in the form of flap surgery, aims to restore form and function for rehabilitation.
Flap surgery refers to the transfer of tissue, with its blood supply, from a healthy part of the body (donor site) to the defect (recipient site). Flaps can be categorised into local, regional and free flaps.
When there is inadequate tissue adjacent to the defect for coverage, regional flaps are harvested from tissue in the vicinity of the defect. Regional flaps are raised based on a specific vascular system. The flap is rotated into the recipient site with its pedicle attached at its base.
Donor sites can be closed by direct suture or skin graft. Examples of regional flaps commonly used in the head and neck include the pectoralis major and latissimus dorsi flap, which are pedicled flaps usually harvested as a myocutaneous flap consisting of muscle and skin.
In addition to reconstructing large defects, these flaps serve to protect the great vessels after neck dissection, especially against the effects of radiation therapy.
The pectoralis major flap is the most widely used regional flap in head and neck cancer reconstruction due to its versatility, reliability and ease of harvest. Its skin paddle is designed over the medial aspect of the muscle.
The flap is raised based on the pectoral branch of the thoracoacromial artery and tunneled through the neck. The pectoralis major flap can be used for defects up to the temporal line, and as a tubular flap to reconstruct the hypopharynx and cervical esophagus.
The skin paddle of the latissimus dorsi flap is designed over the upper two-thirds of the muscle. The flap is raised based on the thoracodorsal artery and tunneled through the axilla into the defect.
The latissimus dorsi flap is the largest soft tissue flap that can be harvested in the body with excellent pedicle length that can reach the anterior midline, and defects as high as the skull vertex. The skin paddle is hairless and the donor scar is less noticeable.