1
|
Namin AW, Ong AA, Agamawi YM, Shumrick C, Ducic Y. Interpreting Lower Trapezius Musculocutaneous Flap Skin Paddle Perfusion with Indocyanine Green Angiography. Facial Plast Surg Aesthet Med 2024; 26:52-57. [PMID: 37428534 DOI: 10.1089/fpsam.2022.0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background: The lower trapezius myocutaneous flap (LTF) is a pedicled flap with clinically significant variability of distal skin flap perfusion. Objective: To compare the incidence of partial flap necrosis before and after the institution of routine intraoperative laser-assisted indocyanine green (ICG) angiography. Methods: This is a retrospective review of all LTF performed between November 2021 and July 2022. The outcomes measured in this study are the distance distal to the inferior border of the trapezius muscle with adequate perfusion, and incidence and degree of partial flap necrosis. Results: Sixteen patients met inclusion criteria with a median age of 64.5 years, and a median defect size of 147 cm2. Most patients (11/16) had undergone previous treatment for malignancy. Before utilizing ICG angiography, 40% (2/5) had partial flap necrosis, whereas after utilizing ICG angiography, 9% (1/11) of patients had partial flap necrosis. Seventy-three percent (8/11) of cases who underwent ICG angiography demonstrated a portion of the skin paddle with inadequate perfusion. The range of skin perfusion distal to the inferior border of the trapezius muscle was 0-7 cm (median, 4). Conclusions: The incidence of partial flap necrosis decreased after institution of routine ICG angiography.
Collapse
Affiliation(s)
- Arya W Namin
- Mercy Clinic Ear, Nose, and Throat, Mercy Hospital St. Louis, St. Louis, Missouri, USA
| | | | - Yusuf M Agamawi
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA
| |
Collapse
|
2
|
Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects. J Plast Reconstr Aesthet Surg 2019; 72:e9-e14. [DOI: 10.1016/j.bjps.2018.12.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 06/08/2018] [Accepted: 12/21/2018] [Indexed: 11/22/2022]
|
3
|
|
4
|
Beckler AD, Ezzat WH, Seth R, Nabili V, Blackwell KE. Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction. JAMA FACIAL PLAST SU 2015; 17:422-6. [DOI: 10.1001/jamafacial.2015.0961] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew D. Beckler
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Waleed H. Ezzat
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Rahul Seth
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
| | - Vishad Nabili
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Keith E. Blackwell
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| |
Collapse
|
5
|
Abstract
BACKGROUND Soft-tissue defects in posterior skull can be challenging for reconstruction. If related to tumor resection, these wound beds are generally irradiated and can be difficult from a recipient-vessel perspective for a free tissue transfer. Locoregional flaps might prove to be important reconstructive option in such patients. There is a very limited data on the usage of pedicled trapezius myocutaneous flaps for such defects. METHODS The authors reviewed existing study for usage of trapezius flap for posterior skull repair and used pedicled trapezius myocutaneous flaps based on the descending branch of superficial cervical artery (SCA) for reconstruction of posterior skull soft-tissue defect in an irradiated and infected wound. RESULTS Two patients were operated for trapezius myocutaneous flap for posterior skull defects complicated by cerebrospinal fluid (CSF) leakage and epidural abscess. There was no recipient or donor-site complication at a mean follow-up of 12.5 months. Neither of the 2 patients had any functional deficits for the entire duration of the follow-up. Although this flap was able to help in controlling the CSF leakage in the first patient, it successfully healed the cavity generated from epidural abscess drainage in the second patient. CONCLUSION The large angle of rotation coupled with the ability to complete the procedure without repositioning the patients makes trapezius myocutaneous flap an attractive option for posterior skull reconstruction. In our limited experience, the pedicled trapezius flaps are a reliable alternative as they are well vascularized and able to obliterate the soft-tissue defect completely. The recipient site healed completely in infected as well as irradiated wound beds. In addition, the donor site can be primarily closed with minimal donor-associated complication.
Collapse
|
6
|
Zenga J, Sharon JD, Santiago P, Nussenbaum B, Haughey BH, Fox IK, Myckatyn TM, Diaz JA, Chicoine MR. Lower Trapezius Flap for Reconstruction of Posterior Scalp and Neck Defects after Complex Occipital-Cervical Surgeries. J Neurol Surg B Skull Base 2015; 76:397-408. [PMID: 26401483 DOI: 10.1055/s-0034-1544123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022] Open
Abstract
Objectives To review the indications, techniques, and outcomes for a series of patients in whom the lower trapezius flaps was used for repair of complex posterior scalp and neck defects after posterior occipital-cervical surgeries. Design Retrospective case series. Setting Tertiary academic hospital. Participants A retrospective review of cases that required complex occipital-cervical repair was performed to identify patients who underwent reconstruction using the lower trapezius flap. Data collected included demographics, clinical presentations, surgical anatomy, operative techniques, and outcomes with review of the pertinent literature. Outcomes Nine patients who underwent reconstruction using the lower trapezius flap were identified. Prior surgical interventions included five complex tumor resections, two patients with multiple instrumented cervical spine surgeries, one patient with a craniotomy for attempted extracranial to intracranial arterial bypass for a basilar aneurysm repair, and a posterior occipital-cervical decompression after trauma. During the median follow-up period of 7 months, all nine single-stage reconstructions resulted in successful healing without major surgical complications. Conclusion Lower trapezius island flaps provide a reliable option for the reconstruction of complex scalp and neck defects that develop after complex occipital-cervical surgeries.
Collapse
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Jeffrey D Sharon
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Paul Santiago
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, United States
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Bruce H Haughey
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Ida K Fox
- Department of Plastic Surgery, Washington University, St. Louis, Missouri, United States
| | - Terence M Myckatyn
- Department of Plastic Surgery, Washington University, St. Louis, Missouri, United States
| | - Jason A Diaz
- Department of Otolaryngology, Washington University, St. Louis, Missouri, United States
| | - Michael R Chicoine
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, United States
| |
Collapse
|
7
|
Can A, Orgill DP, Dietmar Ulrich JO, Mureau MAM. The myocutaneous trapezius flap revisited: a treatment algorithm for optimal surgical outcomes based on 43 flap reconstructions. J Plast Reconstr Aesthet Surg 2014; 67:1669-79. [PMID: 25175273 DOI: 10.1016/j.bjps.2014.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 07/15/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because the vascular anatomy of the trapezius flap is highly variable, choosing the most appropriate flap type and design is essential to optimize outcomes and minimize postoperative complications. The aim of this study was to develop a surgical treatment algorithm for trapezius flap transfers. METHODS The medical files of all consecutive patients with a myocutaneous trapezius flap reconstruction of the head, neck, and upper back area treated at three different university medical centers between July 2001 and November 2012 were reviewed. RESULTS There were 43 consecutive flaps performed in 38 patients with a mean follow-up time of 15 months (range, 1-48 months). Eleven patients had a mentosternal burn scar contracture (12 flaps), 12 patients (13 flaps) presented with cancer, and 15 patients (18 flaps) were suffering from chronic wounds due to failed previous reconstruction (n = 6), osteoradionecrosis (n = 1), chronic infection (n = 3), bronchopleural fistula (n = 3), and pressure sores (n = 2). The mean defect size was 152 cm(2). Sixteen flaps were based on the superficial cervical artery (SCA; type 2), 16 were based on the dorsal scapular artery (DSA; type 3), one was based on the intercostal arteries (type 4), and 10 flaps were based on both the DSA and SCA. Recipient-site complications requiring reoperation occurred in 16.3%, including one total flap failure (2.6%). CONCLUSIONS The trapezius myocutaneous flap is a valuable option to reconstruct various head and neck and upper back defects. Based on our data, a surgical treatment algorithm was developed in an attempt to reduce variation in care and improve clinical outcomes.
Collapse
Affiliation(s)
- Anil Can
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dennis P Orgill
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J O Dietmar Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
8
|
The Lower Trapezius Musculocutaneous Flap for Head and Neck Reconstruction. Ann Plast Surg 2013; 71 Suppl 1:S48-54. [DOI: 10.1097/sap.0000000000000036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
|
10
|
Abstract
OBJECTIVE To discuss surgical reconstructive options and complications in patients with extensive lateral skull base defects. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Eligibility criteria included patients seen between July 1999 and July 2003 with malignant neoplasms of the lateral skull base requiring surgical therapy, with resultant surgical defect not amenable to primary closure. INTERVENTION Surgical extirpation of malignant skull base neoplasm requiring free tissue transfer or rotational flap closure. MAIN OUTCOME MEASURE Closure and healing of surgical defect, intraoperative and postoperative complications, patient survival. RESULTS There were 11 patients, 8 males and 3 females, with an average age of 65 years. Eight patients required trapezius flap reconstruction, whereas one patient required temporalis rotational flap closure, and two patients required rectus abdominus free tissue transfers. There was one perioperative death secondary to cardiac disease. There were no immediate wound complications. One patient developed a delayed partial trapezius flap failure successfully treated with a rectus abdominus flap. CONCLUSIONS The trapezius rotational flap is a reliable means of closing complex lateral skull base defects with minimal morbidity.
Collapse
Affiliation(s)
- Sam J Marzo
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Health System, Maywood, IL, USA.
| | | | | | | |
Collapse
|
11
|
Cole I. The lower trapezius island myocutaneous flap for reconstruction of soft tissue of the lateral skullbase and neck. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1997; 67:452-6. [PMID: 9236613 DOI: 10.1111/j.1445-2197.1997.tb02013.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The lower trapezius island myocutaneous flap (LTIMF) has been described as a method of reconstruction after excision of carcinoma of the head and neck. A high rate of failure and confusion regarding the nomenclature of its vascular supply has been reported in the literature. METHODS The data on six patients whose lateral skullbase and upper neck were reconstructed with an LTIMF were assessed prospectively. RESULTS There was one major flap loss, and one previously irradiated patient had a minor dehiscence. One patient had a small haematoma at the donor site. All wounds were closed primarily and preservation of the accessory nerve to the superior fibres of the trapezius muscle enabled almost normal abduction of the arm. CONCLUSIONS The anatomy and complications of the LTIMF are reviewed and certain recommendations are made to improve its reliability.
Collapse
Affiliation(s)
- I Cole
- Department of Ear, Nose and Throat, Head and Neck Surgery, St Vincents Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Affiliation(s)
- Jarl T. Wathne
- Walter Reed Army Medical Center, Otolaryngology-Head and Neck Surgery Service, Washington, DC 20307–5001
| | - Carl A. Patow
- Walter Reed Army Medical Center, Staff, Otolaryngology-Head and Neck Surgery Service, Washington, DC, 20307–5001, Assistant Professor, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| |
Collapse
|