Cervicopectoral flap in head and neck cancer surgery

Ipsilateral Cervicodeltopectoral Flap: A Forgotten Technique, Revival in the Era of Microvascular Reconstruction

Oral cavity cancer is one of the most common cancers in India responsible for significant morbidity and mortality in Indian subcontinent. Majority of cases present in advanced stages which requires extensive reconstruction following tumor resection. Microvascular free flap reconstruction is now considered standard of care for reconstruction for major head and neck skin-mucosal defects but, many factors still act as hindrance like patient's comorbidities, long operating hours for microvascular reconstruction, logistic and financial issues from patient's side. In such situation it is better to have a backup plan for reconstruction of major head and neck defects using pedicled flaps. Pectoralis major myocutaneous (PMMC) flap has been the workhorse flap for head and neck reconstruction since its introduction four decades ago. But relying too much on PMMC flap for major skin-mucosal defects especially in female patients is associated with complications and risk for flap failure leading to catastrophic and significant patient morbidities. Our study involves the use of two flaps for head and neck reconstuction involving skin-mucosal defects i.e PMMC flap for mucosal defect and cervicodeltopectoral (CDP) flap for skin defect. As of now there has been no retrospective or prospective study done which has given a conclusive statement regarding use of these two flaps simultaneously for head and neck reconstruction to the best of our knowledge. In our experience from the present study, CDP flap offers an excellent alternative for extensive head and neck reconstruction and can be readily included in the surgeon's armamentarium with proper planning and meticulous handling.

The contralateral based Cervico-pectoral rotation flap for large neck defects

PURPOSE

We here describe our technique of contralateral based cervico-pectoral (CCP) flap for the reconstruction of large neck defect following resection of primary tumour or recurrence particularly due to the lymph node mass.

METHODS

The study included the patients who underwent major head and neck surgical ablative procedures followed by CCP flap reconstruction between July 2020 and November 2020. Patients were kept on rigorous regular follow-up to evaluate for flap related complications like flap necrosis, flap dehiscence and oro-cutaneous fistula. Among the 5 patients included and presented in the series, 2 patients were salvage cases post adjuvant treatment.

RESULTS

Five patients who have undergone head and neck reconstruction using CCP flap were included. No major flap related complications occurred in post-operative period.

CONCLUSION

The CCP flap is simple to perform and reproducible and can be added to the armamentarium for the reconstruction of large upper neck defect following resection of primary tumour or recurrence involving the cervical skin in resource limited setting and in contraindication for microvascular reconstruction. Proper planning, meticulous dissection and adequate release or rotation and tension free closure would provide best outcomes.

The faciocervicopectoral flap for non-oncological cases of cheek reconstruction

INTRODUCTION

Major facial defect has been a challenging case for plastic surgeons in terms of wound healing and covering technique for a long time.

METHODS

Eight faciocervicopectoral (FCP) flaps were performed for reconstruction of major cheek defects due to handmade explosive and gun injuries. They were evaluated perioperatively and postoperatively with regard to operative time and operative blood loss as well as the function and cosmetic appearance.

RESULTS

The technique showed marvellous cosmetic results but encountered minor postoperative flap complications.

CONCLUSIONS

The FCP flap is one of the best solutions for coverage of a simple or complex cheek defect. Application of the FCP flap is easy and rapid.

Reconstruction of large lateral facial defects utilizing variations of the cervicopectoral rotation flap

Large lateral facial defects as a result of trauma or head and neck oncologic surgery can present a challenging reconstructive dilemma for the operating surgeon. A number of options currently exist for reconstructing such defects, including skin grafts, myocutaneous flaps, and free vascularized flaps. The decision to utilize one approach versus another depends largely on the nature of the defect, anatomical location, and the experience of the surgeon. This article describes our experience utilizing cervicopectoral rotation flaps with and without myocutaneous flaps to reconstruct large lateral facial defects after head and neck oncologic surgery.