Moshal Tayla, Lasky Sasha, Roohani Idean, Jolibois Marah I, Manasyan Artur, Munabi Naikhoba C O, Fahradyan Artur, Lee Jessica A, Hammoudeh Jeffrey A
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Keck School of Medicine, University of Southern California, Los Angeles, California.
J Reconstr Microsurg. 2025 Feb;41(2):113-122. doi: 10.1055/s-0044-1787741. Epub 2024 Jun 25.
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.
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.
A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports ( = 11) and case series ( = 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 ( = 46, 73.0%) and chronic wounds secondary to H&N masses ( = 9, 14.3%). Defects were most commonly located in the neck ( = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous ( = 48, 71.6%) and based on the dorsal scapular artery ( = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% ( = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years.
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.
当无法进行或不希望进行游离组织移植时，带蒂斜方肌皮瓣对于需要复杂头颈部（H&N）缺损重建的成人来说是一种可行的替代方案。然而，该皮瓣在小儿重建中的应用尚未得到充分探索。本系统评价旨在描述带蒂斜方肌皮瓣的使用情况，并研究其在小儿H&N重建中的疗效。
按照系统评价和Meta分析的首选报告项目指南进行系统评价。纳入描述小儿患者H&N重建中使用斜方肌皮瓣的文章。提取患者人口统计学资料、手术指征、伤口特征、皮瓣特征、并发症和功能结局。
系统评价确定了22篇纳入文章。研究主要包括病例报告（n = 11）和病例系列（n = 8）。总共为63例患者成功实施了67例带蒂斜方肌皮瓣进行H&N重建。最常见的手术指征包括烧伤瘢痕挛缩（n = 46，73.0%）和H&N肿物继发慢性伤口（n = 9, 14.3%）。缺损最常见于颈部（n = 28, 41.8%）。皮瓣平均面积和旋转弧分别为326.4±241.7平方厘米和157.6±33.2度。大多数皮瓣为肌皮瓣（n = 48, 71.6%），且以肩胛背动脉为蒂（n = 32, 47.8%）。10例（14.9%）皮瓣出现并发症。皮瓣存活率为100%（n = 67）。未报告供区功能障碍病例。平均随访时间为2.2±1.8年。
本系统评价证明了带蒂斜方肌皮瓣在小儿H&N重建中的可靠性，并发症发生率低；未报告供区功能障碍；皮瓣存活率为100%。皮瓣较大的表面积、体积和旋转弧有助于其有效覆盖从近端颈部到头皮顶点的软组织缺损。带蒂斜方肌皮瓣是小儿H&N重建中的一种可行选择。
