Head and neck reconstruction with the latissimus dorsi musculocutaneous pedicled flap: functional preservation of the muscle by staged transfer.

The reconstruction of soft-tissue defects in the head and neck region with the latissimus dorsi musculocutaneous pedicled flap is traditionally carried out with dissection of a transaxillary subcutaneous tunnel, which may result in compression of the vascular pedicle in the tunnel, a contour deformity of the neck, or morbidity to the tissues in the axilla and the neck (such as hematoma and seroma). Furthermore, the flaps are often bulky and require secondary defatting. Loss of the muscle causes contour deformity in the back, and its functional loss may be a concern for the patient. To overcome such drawbacks of the traditional use of the flap, we devised a technique of regional transfer of the latissimus dorsi musculocutaneous pedicled island flap to the head and neck region over a pectoral skin bridge rather than utilizing a transaxillary subcutaneous tunnel. This is a two-stage procedure. During the first stage the musculocutaneous flap is transposed in an extracutaneous route to the recipient site. Following a 3-week neovascularization period, the second stage is performed, during which the muscle is detached from its overlying skin island and replaced in situ. This technique was utilized successfully in 5 patients for reconstruction of various head and neck defects with no complications. We conclude that this staged technique of latissimus dorsi musculocutaneous flap transfer to the head and neck region enables functional preservation of the muscle and overcomes many of the complications of the traditional method of utilizing a transaxillary subcutaneous tunnel.