Utility and relevance of modified lateral trapezius myocutaneous flap as a locoregional reconstructive option for medium-sized ablative defects in head and neck cancer—our experience

Singh, Abhishek; Agarwal, Mudit; Singh, Navjot; Chaturvedi, Harit; Venkatasubramaniyan, Manikandan; Chopra, Anshu

doi:10.1007/s00405-020-05952-6

Cited by 1 publication

(1 citation statement)

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“…26,27 Despite no objective rate of shoulder dysfunction within the literature at the time, these claims led the trapezius flap-especially the upper trapezius flap-to fall out of favor among the adult population. 28 A more recent study by Singh et al 29 reported at least some limited shoulder abduction in 94% of adult patients who underwent lateral musculocutaneous trapezius flap reconstruction at their institution, suggesting some truth behind initial fears of functional shoulder disability among adults. Despite no objective data to suggest similar functional impairments among pediatric patients undergoing reconstruction with trapezius flaps, it seems that similar fears led to the flap's unpopularity.…”

Section: Discussionmentioning

confidence: 99%

The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction—A Systematic Review

Moshal,

Lasky,

Roohani

et al. 2024

J Reconstr Microsurg

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Background When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction. Methods A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted. Results A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports (n = 11) and case series (n = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures (n = 46, 73.0%) and chronic wounds secondary to H&N masses (n = 9, 14.3%). Defects were most commonly located in the neck (n = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm2 and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous (n = 48, 71.6%) and based on the dorsal scapular artery (n = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% (n = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years. Conclusion This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.

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