Modified free latissimus dorsi musculocutaneous flap in the reconstruction of extensive postoncologic defects in the head and neck region.
Oncological resection of advanced carcinoma in the head and neck region results in vast defects. The free latissimus dorsi musculocutaneous flap (FLDMF) is one of the most commonly used flaps for the repair of complex head and neck defects. We tried to modify FLDMF to multiple segments or combine it with acellular dermis to fit through-and-through defects in the oral-facial region during the last decade. A retrospective review of patients with FLDMF reconstruction between 2004 and 2012 was undertaken. Demographics, histology, surgical management, disease control and overall survival, complications, radiotherapy, aesthetic outcome, as well as economic results were analyzed. The majority of the patients (66.7%) had recurrent tumors, and the rest of the patients had primary tumor with stage IV. Fourteen patients (38.9%) had a history of prior radiation therapy, whereas 27.8% of the patients had postoperative radiation therapy. The areas of the defects vary from 52 cm to 180 cm (mean, 86.4 cm). The flap failed in 1 of the 37 patients. The complications at the recipient site include hematoma (n = 6, 16.7%), venous insufficiency (n = 4, 11.1%), infection (n = 3, 8.3), and partial flap necrosis (n = 2, 5.5%). The donor-site complications include delayed healing, necrosis of skin graft, and limited shoulder function. The 5-year overall survival rate was 39.1%, and the 5-year disease-free survival rate was 22.1%. In conclusion, the FLDMF could be modified to fit vast defects where voluminous tissue is needed to be transferred in the head and neck region.
From the Departments of *Head and Neck Surgery, and †Stomatology, Sichuan Cancer Hospital, Chengdu, China.
Guiquan
G
Zhu
Chunhua
C
Li
Jin
J
Chen
Yongcong
Y
Cai
Ling
L
Li
Zhaohui
Z
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004954:Esthetics; D005260:Female; D058752:Free Tissue Flaps / Q000601:surgery*; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies