Reconstruction of the total cheek defect by free myocutaneous flap

The free revascularized rectus abdominis myocutaneous flap for the repair of tumour related defects in the head and neck area

The present work reviews a series of 11 consecutive patients who have received free revascularized rectus abdominis myocutaneous flaps for primary reconstruction of soft tissues after ablative tumour surgery in the head and neck area. In 10 patients, a total or subtotal glossectomy had been performed and the flap was used to replace the resected tongue volume. In 5 of these cases, extensive perforating defects had resulted after additional resection of large portions of the chin and the cheek. Mandibular continuity was restored by a metal plate and the flap was divided into an intraoral and extraoral portion in these patients. In one patient, the flap had been used for closure of a full thickness defect of the calvarium. 9 of the 11 flaps healed uneventfully. In one case, a partial flap loss was encountered after thrombosis of the venous pedicle due to compression as a result of an unfavourable defect anatomy and flap positioning. Primary closure of the abdominal wall was achieved in all cases. A subcutaneous hematoma occurred at the donor site in one patient. According to our present experience, the rectus abdominis free flap may serve as an alternative to the frequently employed latissimus dorsi flap in maxillofacial reconstructions while it offers the possibility for flap elevation simultaneously to the surgical procedures in the head and neck area.