Myocutaneous flaps for challenging problems in head and neck reconstruction.

We treated three cases of recurrent head and neck carcinoma viewed as challenging reconstructive problems because of the extent of the extirpative surgery necessary and the substantial risk of complications that would be associated with previous treatment techniques. In each case, the versatility of myocutaneous flaps is illustrated. In case 1, a double-paddle pectoralis major flap was employed. In case 2, with an exposed infected carotid artery and a failed pectoralis major flap, reconstruction was accomplished by using an ipsilateral trapezius myocutaneous flap. In case 3, for reconstruction of the pharynx with a low esophagostoma, a double-paddle pectoralis major and split-thickness skin graft were used.