title: The contralateral bilobed trapezius myocutaneous flap for closure of large defects of the dorsal neck permitting primary donor site closure.
abstract: BACKGROUND
  Various reliable local flaps can be used to cover soft tissue defects of the posterior neck. Among others, the (either vertical or transverse) trapezius myocutaneous flap is a reliable option in this context. However, for defects with a diameter larger than 15 cm, these flaps require skin grafting of the donor site.
  
  
  METHODS
  To prevent this additional morbidity we describe a contralaterally based bilobed trapezius musculocutaneous flap successfully applied in two elderly patients with large tumors of the posterior neck in palliative situations.
  
  
  RESULTS
  This novel approach makes use of a standard vertical skin paddle to cover the neck, together with a transverse cervical flap in a bilobed design to primarily close the paravertebral donor site.
  
  
  CONCLUSIONS
  The bilobed technique allows the primary closure of massive soft tissue neck wounds. Preservation of the accessory nerve to the superior fibers of the trapezius muscle permitted normal arm elevation in our patients.
authors.affiliation: Department of Plastic and Hand Surgery, Albert-Ludwigs-University Freiburg, Medical School, Germany. horch@ch11.ukl.uni-freiberg.de
authors.forename: R E
authors.initials: RE
authors.lastname: Horch
authors.forename: G B
authors.initials: GB
authors.lastname: Stark
mesh_terms: D000055:Accessory Nerve / Q000502:physiology; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000294:innervation / Q000502:physiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008080:Liposarcoma / Q000601:surgery; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation*; D009334:Neck Muscles / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009442:Neurilemmoma / Q000601:surgery; D010166:Palliative Care; D011788:Quality of Life; D015203:Reproducibility of Results; D016038:Skin Transplantation / Q000379:methods; D012983:Soft Tissue Neoplasms / Q000601:surgery; D013524:Surgical Flaps