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

Abstract

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.

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

“…Free flaps have paved the way for reconstruction of large defects with minimal donor site morbidity and maximal defect coverage. But there are a few inherent problems with microvascular reconstruction, including the lack of availability of expertise at every centre, logistic and financial issues, the patient’s general status and medical comorbidities, which restrict the use of free flaps [ 11 ]. These issues have necessitated surgeons to be familiar with locoregional reconstructive options.…”

“…Bakamjian first described the deltopectoral flap in 1965, the pedicle of which was based medially on internal mammary perforators [ 11 ]. After a decade, Daniel and colleagues defined the primary vascular zones of deltopectoral flap [ 7 ].…”

“…Later on, Becker gave a modification in which he included the cervical skin along with deltopectoral flap for reconstruction of large head and neck defects, as he was able to preserve the internal mammary perforators along with the supply from platysma muscle and base of neck [ 7 ]. The various cited advantages of the CDP flap are excellent colour and texture match with availability of adequate tissue adjacent to the primary defect and ability to perform neck dissection in same incision [ 11 ].…”

“…The advantage of the CDP flap, as per our experience, is that it can be modified according to the defect size and shape without much difficulty. Recently, we have described our technique of contralaterally based CDP flap for coverage of head and neck defects [ 11 ]. The CDP is a versatile flap with many applications.…”