title: The myocutaneous trapezius flap revisited: a treatment algorithm for optimal surgical outcomes based on 43 flap reconstructions.
abstract: BACKGROUND
  Because the vascular anatomy of the trapezius flap is highly variable, choosing the most appropriate flap type and design is essential to optimize outcomes and minimize postoperative complications. The aim of this study was to develop a surgical treatment algorithm for trapezius flap transfers.
  
  
  METHODS
  The medical files of all consecutive patients with a myocutaneous trapezius flap reconstruction of the head, neck, and upper back area treated at three different university medical centers between July 2001 and November 2012 were reviewed.
  
  
  RESULTS
  There were 43 consecutive flaps performed in 38 patients with a mean follow-up time of 15 months (range, 1-48 months). Eleven patients had a mentosternal burn scar contracture (12 flaps), 12 patients (13 flaps) presented with cancer, and 15 patients (18 flaps) were suffering from chronic wounds due to failed previous reconstruction (n = 6), osteoradionecrosis (n = 1), chronic infection (n = 3), bronchopleural fistula (n = 3), and pressure sores (n = 2). The mean defect size was 152 cm(2). Sixteen flaps were based on the superficial cervical artery (SCA; type 2), 16 were based on the dorsal scapular artery (DSA; type 3), one was based on the intercostal arteries (type 4), and 10 flaps were based on both the DSA and SCA. Recipient-site complications requiring reoperation occurred in 16.3%, including one total flap failure (2.6%).
  
  
  CONCLUSIONS
  The trapezius myocutaneous flap is a valuable option to reconstruct various head and neck and upper back defects. Based on our data, a surgical treatment algorithm was developed in an attempt to reduce variation in care and improve clinical outcomes.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Can
authors.affiliation: Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Orgill
authors.affiliation: Department of Plastic and Reconstructive Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: J O
authors.initials: JO
authors.lastname: Dietmar Ulrich
authors.affiliation: Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: m.mureau@erasmusmc.nl.
authors.forename: Marc A M
authors.initials: MA
authors.lastname: Mureau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000009:adverse effects* / Q000098:blood supply; D012086:Reoperation; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D060053:Transplant Donor Site
keywords: Myocutaneous flap; Surgical outcome; Trapezius; Treatment algorithm